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This is VAERS ID 311686

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 311686
VAERS Form:
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac failure, Hypertension

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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':

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 abov"e. 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.


Changed on 12/8/2009

VAERS ID: 311686 Before After
VAERS Form:
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac failure, Hypertension

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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': (blank) 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 abov"e. 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


Changed on 2/14/2017

VAERS ID: 311686 Before After
VAERS Form:
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac failure, Hypertension

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 9/14/2017

VAERS ID: 311686 Before After
VAERS Form:(blank) 1
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 2/14/2018

VAERS ID: 311686 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 6/14/2018

VAERS ID: 311686 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 8/14/2018

VAERS ID: 311686 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 9/14/2018

VAERS ID: 311686 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 10/14/2018

VAERS ID: 311686 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 8/14/2019

VAERS ID: 311686 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 12/24/2020

VAERS ID: 311686 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 12/30/2020

VAERS ID: 311686 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 5/7/2021

VAERS ID: 311686 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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


Changed on 5/14/2021

VAERS ID: 311686 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Unknown
Vaccinated:2007-12-18
Onset:2008-03-05
Submitted:2008-05-05
Entered:2008-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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

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