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This is VAERS ID 504269

(NOTE: This result is from the 6/14/2018 version of the VAERS database)

Case Details

VAERS ID: 504269 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Florida  
Vaccinated:2013-01-28
Onset:0000-00-00
Submitted: 2013-09-26
Entered: 2013-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 1 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UH324AC / 1 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. H014561 / 2 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Incorrect dose administered, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-02-21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Splenectomy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient given Pedvax HIB, PPV23 and MPSV4 on 28 Jan 2013 in facility per Dr prescription from PCM for splenectomy. Copy of vaccines given to patient before leaving clinic. On 06 Feb 2013 Patient was admitted to hospital and given as vaccines again due to pharmacist/doctors saying he had not recieved the vaccines. On 02/21/2013 patient passed away at the hospital from kidney failure.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180614&IDNUMBER=504269


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