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This is VAERS ID 207834

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 207834 (history)  
Form: Version .0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2002-11-14
Onset:0000-00-00
Submitted: 2003-08-11
Entered: 2003-08-14
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / AVENTIS PASTEUR, - / - - / -
HEP: HEP B (UNKNOWN MFR) / UNKNOWN MFR - / - - / -
HEPA: HEP A (UNKNOWN MFR) / UNKNOWN MFR - / - - / -
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR, UB245AA / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / -
PPV: PNEUMO, 23-VALENT (PNEUMOVAX) / MERCK & CO. INC. - / - - / -

Administered by: Military       Purchased by: Unknown
Symptoms: COUGH INC, DYSPNEA, INFECT BACT, LAB TEST ABNORM, NO DRUG EFFECT
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-12-15
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:

Write-up:


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=207834


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