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This is VAERS ID 840719

Case Details

VAERS ID: 840719 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2019-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Pneumonia bacterial
SMQs:, Infective pneumonia (narrow)

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: JP0095075131910JPN001060J

Write-up: Pneumonia bacterial; Information has been received from an other health professional concerning an elderly male patient who was vaccinated with pneumococcal vaccine, polyvalent (23-valent) injection (PNEUMOVAX NP) for prophylaxis (date of vaccination, dose and lot number not reported). No concomitant medications were reported. On an unspecified date, the patient developed pneumonia bacterial. On an unspecified date, the patient died of pneumonia bacterial. It was unknown whether an autopsy was performed. Reporter''s comment: Not provided. The reporting other health professional did not assess the relationship of pneumonia bacterial to pneumococcal Vaccine, Polyvalent (23-valent). Upon internal review, pneumonia bacterial was determined to be medically significant.; Reported Cause(s) of Death: Pneumonia bacterial


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