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From the 5/7/2021 release of VAERS data:

This is VAERS ID 864208



Case Details

VAERS ID: 864208 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2019-11-28
Onset:2019-12-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2020-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Antibody test negative, Death, Influenza, Pneumococcal infection, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylactic vaccination
Preexisting Conditions: Medical History/Concurrent Conditions: Decreased immune responsiveness; Poliomyelitis; Comments: Previous Polio patient.
Allergies:
Diagnostic Lab Data:
CDC Split Type: DK0095075132002DNK010698

Write-up: Pneumococcal infection; Influenza; patient developed influenza despite the influenza vaccine; Every second year throughout many years, antibodies were measured following pneumococcal vaccination, and antibodies were very low already 24 months after the vaccinations; This spontaneous report was received from a general practitioner via an sales representative referring to a 67-year-old female patient. The patient''s medical histories included polio and poor response to vaccines. In 2018, the patient was vaccinated with pneumococcal 4 6b 9v 14 18c 19f 23f conj vaccine (crm197)(PREVENAR). Concurrent condition was not reported. Every second year throughout many years, antibodies were measured following pneumococcal vaccination, and antibodies were very low already 24 months after the vaccinations (antibody test negative). The patient therefore received frequent pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX) re-vaccinations since the patient was a high-risk patient. On 28-NOV-2019, the patient was vaccinated with pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX) (strength, dose, route, lot #, expiration date and anatomical location were not reported) for prophylaxis. On the same date, the patient was vaccinated with influenza virus vaccine (unspecified) (strength, dose, route, lot #, expiration date and anatomical location were not reported) for prophylactic vaccination. In late December 2019, the patient developed influenza despite influenza virus vaccine (unspecified). The patient was hospitalized due to the influenza and there was a fatal outcome, and the date of death was unknown. At the hospital, a pneumococcal infection was also diagnosed. The outcome of influenza, pneumococcal infection and vaccination failure was fatal. The outcome of antibodies were very low was unknown. If an autopsy was performed and cause of death were unknown. The causality between pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX) and the events was unknown. Upon internal review, pneumococcal infection was determined to be medically significant.


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