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This is VAERS ID 837417

Case Details

VAERS ID: 837417 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2019-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Septic shock
SMQs:, Toxic-septic shock conditions (narrow), Sepsis (narrow), Opportunistic infections (broad)

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: CO0095075131910COL000470

Write-up: septic shock; Information has been received from a regulatory authority and refers to a 2-year-old male patient. His medical history, concurrent conditions and concomitant medications were not provided. On an unknown date, the patient was vaccinated with the fourth dose of pneumococcal vaccine, polyvalent (23-valent)(manufacturer unknown)(exact dose, route of administration, lot# and expiration date were not reported) for prophylaxis. On an unknown date, the patient developed septic shock. On an unknown date, the patient died due to septic shock. It was unknown if an autopsy was performed. The causality assessment was not provided.; Reported Cause(s) of Death: SEPTIC SHOCK


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