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This is VAERS ID 836162

Case Details

VAERS ID: 836162 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
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: CO0095075131909COL011023

Write-up: death; Information has been received from a regulatory authority, on 20-SEP-2019. This spontaneous report refers to male patient of 4 (units not reported). No information was given regarding the patient''s concurrent conditions, concomitant medications or medical history. On an unknown date, the patient started therapy with pneumococcal vaccine, polyvalent (23-valent) (manufacturer unknown) (dose, route of administration, frequency, lot number and expiration date were not reported) for prophylaxis. On an unknown date, the patient died and the cause or if an autopsy was performed was not reported. The agency considered the event to be possible related to pneumococcal vaccine, polyvalent (23-valent) (manufacturer unknown).


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