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This is VAERS ID 837802

Case Details

VAERS ID: 837802 (history)  
Form: Version 2.0  
Sex: Male  
Location: Foreign  
Submitted: 0000-00-00
Entered: 2019-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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:
Diagnostic Lab Data:
CDC Split Type: CO0095075131910COL002350

Write-up: Septic shock; Information has been received a from Health Authority (agency number was not provided) on 20-SEP-2019. This spontaneous report was received from a Health Authority, concerning to a 2-year-old, male patient. Information about medical history, concurrent conditions and concomitant medications was not provided. On an unknown date, the patient was vaccinated with the fourth dose of hepatitis a vaccine, inactivated (manufacturer unknown) (reported as hepatitis A purified antigen) (strength, formulation, dose, anatomical location of vaccination, route of administration, indication, lot number and expiration date were not reported). On an unknown date, the patient experienced septic shock and and consequently the patient died. The causality assessment between therapy with hepatitis a vaccine, inactivated (manufacturer unknown) and the aforementioned event was not reported.

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