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This is VAERS ID 311791

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 311791
VAERS Form:
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / SC

Administered by: Other      Purchased by: Unknown
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently,"on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recov


Changed on 12/8/2009

VAERS ID: 311791 Before After
VAERS Form:
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / SC

Administered by: Other      Purchased by: Unknown Other
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0804USA06377

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently,"on Subsequently, on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recov recovery. It was also reported that the patient went on vacation and when she returned from vacation she developed pneumonia and died on 12-APR-2008. There was no product quality complaint involved. The cause of death was pneumonia. The nurse practitioner considered the event to be disabling. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 311791 Before After
VAERS Form:(blank) 1
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UNK UN / SC

Administered by: Other      Purchased by: Other
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA06377

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently, on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recovery. It was also reported that the patient went on vacation and when she returned from vacation she developed pneumonia and died on 12-APR-2008. There was no product quality complaint involved. The cause of death was pneumonia. The nurse practitioner considered the event to be disabling. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 311791 Before After
VAERS Form:1
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other      Purchased by: Other
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA06377

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently, on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recovery. It was also reported that the patient went on vacation and when she returned from vacation she developed pneumonia and died on 12-APR-2008. There was no product quality complaint involved. The cause of death was pneumonia. The nurse practitioner considered the event to be disabling. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 311791 Before After
VAERS Form:1
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other      Purchased by: Other
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA06377

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently, on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recovery. It was also reported that the patient went on vacation and when she returned from vacation she developed pneumonia and died on 12-APR-2008. There was no product quality complaint involved. The cause of death was pneumonia. The nurse practitioner considered the event to be disabling. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 311791 Before After
VAERS Form:1
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other      Purchased by: Other
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA06377

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently, on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recovery. It was also reported that the patient went on vacation and when she returned from vacation she developed pneumonia and died on 12-APR-2008. There was no product quality complaint involved. The cause of death was pneumonia. The nurse practitioner considered the event to be disabling. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 311791 Before After
VAERS Form:1
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other      Purchased by: Other
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA06377

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently, on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recovery. It was also reported that the patient went on vacation and when she returned from vacation she developed pneumonia and died on 12-APR-2008. There was no product quality complaint involved. The cause of death was pneumonia. The nurse practitioner considered the event to be disabling. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 311791 Before After
VAERS Form:1
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other      Purchased by: Other
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA06377

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently, on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recovery. It was also reported that the patient went on vacation and when she returned from vacation she developed pneumonia and died on 12-APR-2008. There was no product quality complaint involved. The cause of death was pneumonia. The nurse practitioner considered the event to be disabling. Additional information has been requested.


Changed on 8/14/2019

VAERS ID: 311791 Before After
VAERS Form:1
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other      Purchased by: Other
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA06377

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently, on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recovery. It was also reported that the patient went on vacation and when she returned from vacation she developed pneumonia and died on 12-APR-2008. There was no product quality complaint involved. The cause of death was pneumonia. The nurse practitioner considered the event to be disabling. Additional information has been requested.


Changed on 12/24/2020

VAERS ID: 311791 Before After
VAERS Form:1
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other      Purchased by: Other
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA06377

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently, on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recovery. It was also reported that the patient went on vacation and when she returned from vacation she developed pneumonia and died on 12-APR-2008. There was no product quality complaint involved. The cause of death was pneumonia. The nurse practitioner considered the event to be disabling. Additional information has been requested.


Changed on 12/30/2020

VAERS ID: 311791 Before After
VAERS Form:1
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other      Purchased by: Other
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA06377

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently, on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recovery. It was also reported that the patient went on vacation and when she returned from vacation she developed pneumonia and died on 12-APR-2008. There was no product quality complaint involved. The cause of death was pneumonia. The nurse practitioner considered the event to be disabling. Additional information has been requested.


Changed on 5/7/2021

VAERS ID: 311791 Before After
VAERS Form:1
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other      Purchased by: Other
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA06377

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently, on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recovery. It was also reported that the patient went on vacation and when she returned from vacation she developed pneumonia and died on 12-APR-2008. There was no product quality complaint involved. The cause of death was pneumonia. The nurse practitioner considered the event to be disabling. Additional information has been requested.


Changed on 5/14/2021

VAERS ID: 311791 Before After
VAERS Form:1
Age:83.0
Sex:Female
Location:Unknown
Vaccinated:2008-02-14
Onset:2008-02-20
Submitted:2008-05-06
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / SC

Administered by: Other      Purchased by: Other
Symptoms: Death, Herpes zoster, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-12
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZOVIRAX; Clorazepate dipotassium
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA06377

Write-up: Information has been received from a nurse practitioner concerning an 83 year old female consumer who on 14-FEB-2008 was vaccinated SQ with a 0.65ml of ZOSTAVAX. Concomitant therapy included acyclovir (ZOVIRAX) and clorazepate dipotassium. Subsequently, on 20-FEB-2008, the patient developed shingles. Unspecified medical attention was sought. It was unspecified if lab studies were performed. It was reported that the patient was treated for shingles (treatment regimen not reported) and made a full recovery. It was also reported that the patient went on vacation and when she returned from vacation she developed pneumonia and died on 12-APR-2008. There was no product quality complaint involved. The cause of death was pneumonia. The nurse practitioner considered the event to be disabling. Additional information has been requested.

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