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This is VAERS ID 462360

Case Details

VAERS ID: 462360 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2012-07-19
Onset:2012-07-24
   Days after vaccination:5
Submitted: 2012-08-19
   Days after onset:26
Entered: 2012-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK RA / SC

Administered by: Other       Purchased by: Other
Symptoms: Autopsy, Death
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2012-07-24
   Days after onset: 0
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Carvedilol; Lisinopril; COUMADIN; Spironolactone
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1208USA005366

Write-up: This spontaneous report was received from a pharmacist refers to a 72 years old male patient with no known drug allergies who was vaccinated subcutaneously into upper left deltoid with a dose of 0.65 ml ZOSTAVAX (lot # 672563/1649AA, expiration date 21-JAN-2013) on 19-JUL-2012. No other co-suspects were reported. Concomitant medications included lisinopril, COUMADIN, spironolactone and carvedilol. Pharmacist stated she read in the local paper and found out that client was died at her home residence on 24-JUL-2012. Cause of death was unknown. It was unknown if autopsy was performed. Pharmacist stated the patient did have health conditions, unspecified, but she wanted to make sure that no problem existed with this ZOSTAVAX lot number. This event (death) was considered to be life-threatening and disabling. This is one of the two reports from the same reporter. Additional information has been requested.


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