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This is VAERS ID 462360

History of Changes from the VAERS Wayback Machine

First Appeared on 9/12/2012

VAERS ID: 462360
VAERS Form:
Age:72
Sex:Male
Location:Unknown
Vaccinated:2012-07-19
Onset:2012-07-24
Submitted:2012-08-19
Entered:2012-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / - RA / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-07-24
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? 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.


Changed on 6/14/2014

VAERS ID: 462360 Before After
VAERS Form:
Age:72 72.0
Sex:Male
Location:Unknown
Vaccinated:2012-07-19
Onset:2012-07-24
Submitted:2012-08-19
Entered:2012-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / - RA / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-07-24
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? 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.


Changed on 4/14/2017

VAERS ID: 462360 Before After
VAERS Form:
Age:72.0
Sex:Male
Location:Unknown
Vaccinated:2012-07-19
Onset:2012-07-24
Submitted:2012-08-19
Entered:2012-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / - RA / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-07-24
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? 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.


Changed on 9/14/2017

VAERS ID: 462360 Before After
VAERS Form:(blank) 1
Age:72.0
Sex:Male
Location:Unknown
Vaccinated:2012-07-19
Onset:2012-07-24
Submitted:2012-08-19
Entered:2012-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / - UNK RA / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-07-24
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? 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.


Changed on 2/14/2018

VAERS ID: 462360 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Unknown
Vaccinated:2012-07-19
Onset:2012-07-24
Submitted:2012-08-19
Entered:2012-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK RA / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-07-24
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? 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.


Changed on 6/14/2018

VAERS ID: 462360 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Unknown
Vaccinated:2012-07-19
Onset:2012-07-24
Submitted:2012-08-19
Entered:2012-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK RA / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-07-24
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? 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.


Changed on 8/14/2018

VAERS ID: 462360 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Unknown
Vaccinated:2012-07-19
Onset:2012-07-24
Submitted:2012-08-19
Entered:2012-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK RA / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-07-24
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? 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.


Changed on 9/14/2018

VAERS ID: 462360 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Unknown
Vaccinated:2012-07-19
Onset:2012-07-24
Submitted:2012-08-19
Entered:2012-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK RA / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-07-24
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? 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.


Changed on 10/14/2018

VAERS ID: 462360 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Unknown
Vaccinated:2012-07-19
Onset:2012-07-24
Submitted:2012-08-19
Entered:2012-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK RA / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-07-24
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? 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.


Changed on 8/14/2019

VAERS ID: 462360 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Unknown
Vaccinated:2012-07-19
Onset:2012-07-24
Submitted:2012-08-19
Entered:2012-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK RA / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-07-24
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? 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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