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This is VAERS ID 462902

History of Changes from the VAERS Wayback Machine

First Appeared on 9/12/2012

VAERS ID: 462902
VAERS Form:
Age:63
Sex:Female
Location:Unknown
Vaccinated:2012-04-16
Onset:2012-04-18
Submitted:2012-08-23
Entered:2012-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / - LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-04-18
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: 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.


Changed on 6/14/2014

VAERS ID: 462902 Before After
VAERS Form:
Age:63 63.0
Sex:Female
Location:Unknown
Vaccinated:2012-04-16
Onset:2012-04-18
Submitted:2012-08-23
Entered:2012-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / - LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-04-18
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: 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.


Changed on 4/14/2017

VAERS ID: 462902 Before After
VAERS Form:
Age:63.0
Sex:Female
Location:Unknown
Vaccinated:2012-04-16
Onset:2012-04-18
Submitted:2012-08-23
Entered:2012-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / - LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-04-18
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: 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.


Changed on 9/14/2017

VAERS ID: 462902 Before After
VAERS Form:(blank) 1
Age:63.0
Sex:Female
Location:Unknown
Vaccinated:2012-04-16
Onset:2012-04-18
Submitted:2012-08-23
Entered:2012-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / - UNK LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-04-18
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: 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.


Changed on 2/14/2018

VAERS ID: 462902 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Unknown
Vaccinated:2012-04-16
Onset:2012-04-18
Submitted:2012-08-23
Entered:2012-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-04-18
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: 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.


Changed on 6/14/2018

VAERS ID: 462902 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Unknown
Vaccinated:2012-04-16
Onset:2012-04-18
Submitted:2012-08-23
Entered:2012-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-04-18
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: 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.


Changed on 8/14/2018

VAERS ID: 462902 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Unknown
Vaccinated:2012-04-16
Onset:2012-04-18
Submitted:2012-08-23
Entered:2012-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-04-18
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: 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.


Changed on 9/14/2018

VAERS ID: 462902 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Unknown
Vaccinated:2012-04-16
Onset:2012-04-18
Submitted:2012-08-23
Entered:2012-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-04-18
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: 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.


Changed on 10/14/2018

VAERS ID: 462902 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Unknown
Vaccinated:2012-04-16
Onset:2012-04-18
Submitted:2012-08-23
Entered:2012-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-04-18
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: 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.


Changed on 8/14/2019

VAERS ID: 462902 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Unknown
Vaccinated:2012-04-16
Onset:2012-04-18
Submitted:2012-08-23
Entered:2012-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 1649AA / UNK LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-04-18
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: 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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