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This is VAERS ID 837594

Case Details

VAERS ID: 837594 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2019-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Vaccination complication
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: CO0095075131910COL001494

Write-up: Vaccination complication; This spontaneous report was received from a regulatory authority referring to a 2 year old male patient. Information regarding the patient''s concurrent conditions, past medical history and concomitant medications was not provided. On an unknown date, the patient was vaccinated with a dose of varicella virus vaccine live (oka/merck) (VARICELLA VIRUS VACCINE LIVE (OKA/MERCK)), reported as dose 3 (strength, route of administration, lot #, expiration date and indication were not reported). On an unknown date, the patient experienced vaccination complication and the patient died. The cause of death and if an autopsy was performed were unknown. The causality assessment was not reported by the agency.


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