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This is VAERS ID 315005

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 315005
VAERS Form:
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''''None''''. We would be happy to forward the Study''''s SAE Report Form upon request (Alexi"s at fax: 612-625-0080). Subject ID is I105031.


Changed on 12/8/2009

VAERS ID: 315005 Before After
VAERS Form:
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''''None''''. ''None''. We would be happy to forward the Study''''s Study''s SAE Report Form upon request (Alexi"s (Alexis at fax: 612-625-0080). Subject ID is I105031.


Changed on 3/2/2010

VAERS ID: 315005 Before After
VAERS Form:
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request (Alexis at fax: 612-625-0080). Subject ID is I105031.


Changed on 4/7/2010

VAERS ID: 315005 Before After
VAERS Form:
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request (Alexis at fax: 612-625-0080). Subject ID is I105031.


Changed on 8/31/2010

VAERS ID: 315005 Before After
VAERS Form:
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request (Alexis at fax: 612-625-0080). Subject ID is I105031.


Changed on 1/7/2013

VAERS ID: 315005 Before After
VAERS Form:
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request (Alexis at fax: 612-625-0080). Subject ID is I105031. request.


Changed on 9/14/2017

VAERS ID: 315005 Before After
VAERS Form:(blank) 1
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request.


Changed on 2/14/2018

VAERS ID: 315005 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request.


Changed on 6/14/2018

VAERS ID: 315005 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request.


Changed on 8/14/2018

VAERS ID: 315005 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request.


Changed on 9/14/2018

VAERS ID: 315005 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request.


Changed on 10/14/2018

VAERS ID: 315005 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request.


Changed on 12/24/2020

VAERS ID: 315005 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request.


Changed on 12/30/2020

VAERS ID: 315005 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request.


Changed on 5/7/2021

VAERS ID: 315005 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request.


Changed on 5/14/2021

VAERS ID: 315005 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Pennsylvania
Vaccinated:2007-08-02
Onset:2008-05-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-26
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=315005&WAYBACKHISTORY=ON


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