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This is VAERS ID 607577

Case Details

VAERS ID: 607577 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Foreign  
Vaccinated:2015-05-26
Onset:2015-06-12
   Days after vaccination:17
Submitted: 2015-08-14
   Days after onset:63
Entered: 2015-08-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 144801 / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2015-06-12
   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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHHY2015DE097863

Write-up: Case number PHHY2015DE097863, is an initial spontaneous report from Health Authority (reference number: DE-PEI-PEI2015048324) received on 11 Aug 2015. This report refers to a 28-month-old male patient. Historical conditions were not reported. No concomitant medication was reported. Vaccination history included administration of first dose of BEXSERO (batch number: 144801) on 02 Mar 2015 and the patient tolerated the vaccine well. The patient was vaccinated with the second dose of BEXSERO (batch number: 144801) intramuscularly on 26 May 2015. On 12 Jun 2015, 17 days after receiving the second vaccination, the patient died from an unknown cause. Causality was not reported. It was not reported whether an autopsy was performed.


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