National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 311686

Government Disclaimer on use of this data



Case Details

VAERS ID: 311686 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2007-12-18
Onset:2008-03-05
   Days after vaccination:78
Submitted: 2008-05-05
   Days after onset:60
Entered: 2008-05-06
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: diabetes; benign prostatic hyperplasia and hyperlipidaemia
Preexisting Conditions: myocardial infraction (1996) and cataract operation
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0804USC00103

Write-up: Information has been received from an investigator concerning a 68 year old male with diabetes, benign prostatic hyperplasia and hyperlipidaemia and a history of myocardial infarction (1996) and cataract operation who entered a study, title as stated above. On 18-DEC-2007 the patient was vaccinated with blinded therapy. On 08-MAR-2008 the patient died. The cause of death was unknown. At this time, relationship of death to study therapy is unknown. The records for this patient was unblinded on 01-MAY-2008. The patient was treated with Zostavax (Oka/Merck) 0.65 ml. Additional information has been requested. 5/7/08-record received Cause of Death: Cardiac insufficiency. Diabetes. Hypertension


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=311686


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166