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This is VAERS ID 432209

Case Details

VAERS ID: 432209 (history)  
Form: Version 1.0  
Age: 48.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2011-08-25
Onset:0000-00-00
Submitted: 2011-08-30
Entered: 2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0103AA / 2 LA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-08-27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. wife reports pt. died.


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