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This is VAERS ID 462902

Case Details

VAERS ID: 462902 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2012-04-16
Onset:2012-04-18
   Days after vaccination:2
Submitted: 2012-08-23
   Days after onset:127
Entered: 2012-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK LA / SC

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2012-04-18
   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: acyclovir; PERCOCET; clonazepam; lovastatin; amlodipine
Current Illness: Medical observation normal
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1208USA005076

Write-up: This spontaneous report as received from a pharmacist refers to a 63 years old female patient with no known allergies. The patient was vaccinated subcutaneous into upper left deltoid with 0.65 ml ZOSTAVAX (lot # 672563/1649AA, expiration date 21-JAN-2013) on 16-APR-2012. No other co-suspects were reported. Concomitant medications included acyclovir, acetaminophen, PERCOCET, clonazepam, lovastatin and amlodipine. Pharmacist stated she read the local paper and found out that client was found dead at her home residence on 18-APR-2012, due to natural causes. Pharmacist stated the patient did have health conditions, unspecified, but she wanted to make sure that no problem existed with this ZOSTAVAX lot number. Lot check was requested by the reporter. Event was considered to be disabling and life-threatening. This is one of the two reports from the same reporter. Additional information has been requested.


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