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This is VAERS ID 504269

History of Changes from the VAERS Wayback Machine

First Appeared on 10/13/2013

VAERS ID: 504269
VAERS Form:
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 / 0 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UH324AC / 0 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. H014561 / 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Renal failure, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 9/14/2017

VAERS ID: 504269 Before After
VAERS Form:(blank) 1
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 / 0 1 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UH324AC / 0 1 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. H014561 / 1 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Renal failure, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 2/14/2018

VAERS ID: 504269 Before After
VAERS Form:1
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, Renal failure, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 6/14/2018

VAERS ID: 504269 Before After
VAERS Form:1
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, Renal failure, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 8/14/2018

VAERS ID: 504269 Before After
VAERS Form:1
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, Renal failure, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 9/14/2018

VAERS ID: 504269 Before After
VAERS Form:1
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, Renal failure, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 10/14/2018

VAERS ID: 504269 Before After
VAERS Form:1
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, Renal failure, Incorrect dose administered

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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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