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This is VAERS ID 835957

Case Details

VAERS ID: 835957 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2019-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO0095075131909COL010919

Write-up: death; Information has been received from the agency on 20-SEP-2019 concerning a 4 month old infant female patient. The patient?s concurrent conditions, pertinent medical and concomitant medications were not reported. On an unknown date the patient was vaccinated with pneumococcal vaccine, polyvalent (23-valent) (manufacturer unknown), dose, route, anatomical location, lot number and expiration date were not reported. On an unknown date, the patient died form an unknown cause. It was unknown if an autopsy was performed. The agency did not report the causality assessment between the suspect therapy and the patient?s death.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


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