National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 607577

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2015

VAERS ID: 607577
VAERS Form:
Age:2.0
Sex:Male
Location:Foreign
Vaccinated:2015-05-26
Onset:2015-06-12
Submitted:2015-08-14
Entered:2015-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 144801 / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-06-12
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: 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.


Changed on 9/14/2017

VAERS ID: 607577 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Male
Location:Foreign
Vaccinated:2015-05-26
Onset:2015-06-12
Submitted:2015-08-14
Entered:2015-08-19
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-06-12
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: 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.


Changed on 2/14/2018

VAERS ID: 607577 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Foreign
Vaccinated:2015-05-26
Onset:2015-06-12
Submitted:2015-08-14
Entered:2015-08-19
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-06-12
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: 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.


Changed on 6/14/2018

VAERS ID: 607577 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Foreign
Vaccinated:2015-05-26
Onset:2015-06-12
Submitted:2015-08-14
Entered:2015-08-19
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-06-12
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: 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.


Changed on 8/14/2018

VAERS ID: 607577 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Foreign
Vaccinated:2015-05-26
Onset:2015-06-12
Submitted:2015-08-14
Entered:2015-08-19
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-06-12
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: 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.


Changed on 9/14/2018

VAERS ID: 607577 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Foreign
Vaccinated:2015-05-26
Onset:2015-06-12
Submitted:2015-08-14
Entered:2015-08-19
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-06-12
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: 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.


Changed on 10/14/2018

VAERS ID: 607577 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Foreign
Vaccinated:2015-05-26
Onset:2015-06-12
Submitted:2015-08-14
Entered:2015-08-19
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-06-12
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: 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.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=607577&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166