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This is VAERS ID 312251

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 312251
VAERS Form:
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Atrial fibrillation, Blood creatinine increased, Blood urea increased, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''''None''''. We would be happ"y to forward the Study''''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation w


Changed on 12/8/2009

VAERS ID: 312251 Before After
VAERS Form:
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Atrial fibrillation, Blood creatinine increased, Blood urea increased, Bronchitis, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Gastrointestinal haemorrhage, Haemoglobin decreased, Hyperhidrosis, Multi-organ failure, Myocardial infarction, Pyrexia, Renal failure, Respiratory failure, Wheezing, Troponin increased, Occult blood positive, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''''None''''. ''None''. We would be happ"y happy to forward the Study''''s Study''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation w with rapid ventricular response. Acute Bronchitis. COPD. Gastrointestinal bleeding. Anemia. Hyperlipidemia. Pt presented to ER with 2 day hx of cough and fever with worsening shortness of breath with diaphoresis. Pt also had diarrhea 1 day prior to ER visit. On admission, troponin was (+). PE (+) for I&E wheezing and decreased breath sounds. Pt developed atrial fib, GI bleeding, and acute on chronic renal failure during hospitalization: multi-system organ failure. Transferred to hospice on 2/10/08 per pt request. Pt expired on 2/11/08.


Changed on 4/14/2017

VAERS ID: 312251 Before After
VAERS Form:
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Atrial fibrillation, Blood creatinine increased, Blood urea increased, Bronchitis, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Gastrointestinal haemorrhage, Haemoglobin decreased, Hyperhidrosis, Multi-organ failure, Myocardial infarction, Pyrexia, Renal failure, Respiratory failure, Wheezing, Troponin increased, Occult blood positive, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation with rapid ventricular response. Acute Bronchitis. COPD. Gastrointestinal bleeding. Anemia. Hyperlipidemia. Pt presented to ER with 2 day hx of cough and fever with worsening shortness of breath with diaphoresis. Pt also had diarrhea 1 day prior to ER visit. On admission, troponin was (+). PE (+) for I&E wheezing and decreased breath sounds. Pt developed atrial fib, GI bleeding, and acute on chronic renal failure during hospitalization: multi-system organ failure. Transferred to hospice on 2/10/08 per pt request. Pt expired on 2/11/08.


Changed on 9/14/2017

VAERS ID: 312251 Before After
VAERS Form:(blank) 1
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation with rapid ventricular response. Acute Bronchitis. COPD. Gastrointestinal bleeding. Anemia. Hyperlipidemia. Pt presented to ER with 2 day hx of cough and fever with worsening shortness of breath with diaphoresis. Pt also had diarrhea 1 day prior to ER visit. On admission, troponin was (+). PE (+) for I&E wheezing and decreased breath sounds. Pt developed atrial fib, GI bleeding, and acute on chronic renal failure during hospitalization: multi-system organ failure. Transferred to hospice on 2/10/08 per pt request. Pt expired on 2/11/08.


Changed on 2/14/2018

VAERS ID: 312251 Before After
VAERS Form:1
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation with rapid ventricular response. Acute Bronchitis. COPD. Gastrointestinal bleeding. Anemia. Hyperlipidemia. Pt presented to ER with 2 day hx of cough and fever with worsening shortness of breath with diaphoresis. Pt also had diarrhea 1 day prior to ER visit. On admission, troponin was (+). PE (+) for I&E wheezing and decreased breath sounds. Pt developed atrial fib, GI bleeding, and acute on chronic renal failure during hospitalization: multi-system organ failure. Transferred to hospice on 2/10/08 per pt request. Pt expired on 2/11/08.


Changed on 6/14/2018

VAERS ID: 312251 Before After
VAERS Form:1
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation with rapid ventricular response. Acute Bronchitis. COPD. Gastrointestinal bleeding. Anemia. Hyperlipidemia. Pt presented to ER with 2 day hx of cough and fever with worsening shortness of breath with diaphoresis. Pt also had diarrhea 1 day prior to ER visit. On admission, troponin was (+). PE (+) for I&E wheezing and decreased breath sounds. Pt developed atrial fib, GI bleeding, and acute on chronic renal failure during hospitalization: multi-system organ failure. Transferred to hospice on 2/10/08 per pt request. Pt expired on 2/11/08.


Changed on 8/14/2018

VAERS ID: 312251 Before After
VAERS Form:1
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation with rapid ventricular response. Acute Bronchitis. COPD. Gastrointestinal bleeding. Anemia. Hyperlipidemia. Pt presented to ER with 2 day hx of cough and fever with worsening shortness of breath with diaphoresis. Pt also had diarrhea 1 day prior to ER visit. On admission, troponin was (+). PE (+) for I&E wheezing and decreased breath sounds. Pt developed atrial fib, GI bleeding, and acute on chronic renal failure during hospitalization: multi-system organ failure. Transferred to hospice on 2/10/08 per pt request. Pt expired on 2/11/08.


Changed on 9/14/2018

VAERS ID: 312251 Before After
VAERS Form:1
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation with rapid ventricular response. Acute Bronchitis. COPD. Gastrointestinal bleeding. Anemia. Hyperlipidemia. Pt presented to ER with 2 day hx of cough and fever with worsening shortness of breath with diaphoresis. Pt also had diarrhea 1 day prior to ER visit. On admission, troponin was (+). PE (+) for I&E wheezing and decreased breath sounds. Pt developed atrial fib, GI bleeding, and acute on chronic renal failure during hospitalization: multi-system organ failure. Transferred to hospice on 2/10/08 per pt request. Pt expired on 2/11/08.


Changed on 10/14/2018

VAERS ID: 312251 Before After
VAERS Form:1
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation with rapid ventricular response. Acute Bronchitis. COPD. Gastrointestinal bleeding. Anemia. Hyperlipidemia. Pt presented to ER with 2 day hx of cough and fever with worsening shortness of breath with diaphoresis. Pt also had diarrhea 1 day prior to ER visit. On admission, troponin was (+). PE (+) for I&E wheezing and decreased breath sounds. Pt developed atrial fib, GI bleeding, and acute on chronic renal failure during hospitalization: multi-system organ failure. Transferred to hospice on 2/10/08 per pt request. Pt expired on 2/11/08.


Changed on 12/24/2020

VAERS ID: 312251 Before After
VAERS Form:1
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation with rapid ventricular response. Acute Bronchitis. COPD. Gastrointestinal bleeding. Anemia. Hyperlipidemia. Pt presented to ER with 2 day hx of cough and fever with worsening shortness of breath with diaphoresis. Pt also had diarrhea 1 day prior to ER visit. On admission, troponin was (+). PE (+) for I&E wheezing and decreased breath sounds. Pt developed atrial fib, GI bleeding, and acute on chronic renal failure during hospitalization: multi-system organ failure. Transferred to hospice on 2/10/08 per pt request. Pt expired on 2/11/08.


Changed on 12/30/2020

VAERS ID: 312251 Before After
VAERS Form:1
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation with rapid ventricular response. Acute Bronchitis. COPD. Gastrointestinal bleeding. Anemia. Hyperlipidemia. Pt presented to ER with 2 day hx of cough and fever with worsening shortness of breath with diaphoresis. Pt also had diarrhea 1 day prior to ER visit. On admission, troponin was (+). PE (+) for I&E wheezing and decreased breath sounds. Pt developed atrial fib, GI bleeding, and acute on chronic renal failure during hospitalization: multi-system organ failure. Transferred to hospice on 2/10/08 per pt request. Pt expired on 2/11/08.


Changed on 5/7/2021

VAERS ID: 312251 Before After
VAERS Form:1
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation with rapid ventricular response. Acute Bronchitis. COPD. Gastrointestinal bleeding. Anemia. Hyperlipidemia. Pt presented to ER with 2 day hx of cough and fever with worsening shortness of breath with diaphoresis. Pt also had diarrhea 1 day prior to ER visit. On admission, troponin was (+). PE (+) for I&E wheezing and decreased breath sounds. Pt developed atrial fib, GI bleeding, and acute on chronic renal failure during hospitalization: multi-system organ failure. Transferred to hospice on 2/10/08 per pt request. Pt expired on 2/11/08.


Changed on 5/14/2021

VAERS ID: 312251 Before After
VAERS Form:1
Age:78.0
Sex:Unknown
Location:Pennsylvania
Vaccinated:2008-01-07
Onset:2008-02-05
Submitted:2008-05-13
Entered:2008-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-02-10
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:
Current Illness: COPD
Preexisting Conditions: PMH: Emphysema/COPD, HTN, hypercholesterolemia, basal cell carcinoma. NKDA. Past hx of smoking-quit 2001.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Troponin 0.25, 1.14. Creatinine 1.9. BUN 39 up to 52. EKG sinus tach with PVCs. CBC with WBCs 5.9. Hgb initially 13.1 down to 11.1 CXR with no acute infiltrates (+) emphysematous changes. Stool hemoccult (+).
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD, was hospitalized for COPD exacerbation. Vaccination took place on 1/7/2008 and hospital admission was on 2/5/2008. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request. 5/19/2008 MR received for DOS 2/5-10/2008 with D/C DX: Non-ST segment elevation Myocardial Infarction. Acute on chronic respiratory failure. Acute on chronic renal failure. Atrial Fibrillation with rapid ventricular response. Acute Bronchitis. COPD. Gastrointestinal bleeding. Anemia. Hyperlipidemia. Pt presented to ER with 2 day hx of cough and fever with worsening shortness of breath with diaphoresis. Pt also had diarrhea 1 day prior to ER visit. On admission, troponin was (+). PE (+) for I&E wheezing and decreased breath sounds. Pt developed atrial fib, GI bleeding, and acute on chronic renal failure during hospitalization: multi-system organ failure. Transferred to hospice on 2/10/08 per pt request. Pt expired on 2/11/08.

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