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This is VAERS ID 742170

Case Details

VAERS ID: 742170 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2018-02-19
Onset:2018-02-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2018-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER VNS1R13B / 1 RA / UN
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER N010906 / 1 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2018-02-26
   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:
Current Illness: Common cold; Routine childhood immunization
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NL0095075131803NLD008999

Write-up: Information has been downloaded from regulatory authority (NL-LRB-00273847 and NL-LRB-00274514). This spontaneous report has been received from a consumer concerning a 14 month old male patient. The patient''s concurrent conditions included common cold which started on an unknown date in December 2017. The patient''s medical history, drug allergies and concomitant therapies were not reported. On 19-FEB-2018, the patient was vaccinated with the first dose of M-M-RVAXPRO 0.5ml, with lot number N010906 and expiration date on 31-MAR-2019, 1 Dosage Form administered in the left upper arm for routine childhood immunization (route of administration was not provided). Other suspect therapies included the first dose of NEISVAC-C 20microgram/ml, with lot number VNS1R13B, 1 Dosage Form administered in the right upper arm for routine childhood immunization (route of administration was not provided). On 26-FEB-2018, 7 days after vaccination the patient was found dead in bed. It were unknown the cause of death and if an autopsy was performed. The causal relationship between the suspect therapies and the events was reported as possible. Reported Cause(s) of Death: cause of death unknown, results investigation of death cause follow.


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