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From the 4/7/2010 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 315005

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Case Details

VAERS ID: 315005 (history)  
Form: Version .0  
Age: 63.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2007-08-02
Onset:2008-05-26
   Days after vaccination:298
Submitted: 2008-06-05
   Days after onset:10
Entered: 2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-05-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COPD,
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Subject in pneumococcal vaccine trial, with severe COPD died of respiratory arrest on the way to the hospital. According to the physician, relationship to treatment is ''None''. We would be happy to forward the Study''s SAE Report Form upon request (Alexis at fax: 612-625-0080). Subject ID is I105031.


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