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This is VAERS ID 837419

Case Details

VAERS ID: 837419 (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
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (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: CO0095075131910COL000712

Write-up: respiratory failure; This spontaneous report was received from an Agency and refers to a 2-year-old male patient. His concurrent conditions, medical history and concomitant medications were not provided. On an unknown date, the patient was vaccinated with hepatitis a vaccine, inactivated (manufacturer unknown), dose reported as 4 (units not provided) (strength, route of administration, lot number and expiration date were not reported) for prophylaxis. On an unknown date, the patient experienced respiratory failure. Due to the event, he died on an unknown date. It was unknown, if an autopsy was performed. The relatedness between the event of respiratory failure and suspect vaccine was not provided.; Reported Cause(s) of Death: respiratory failure


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