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This is VAERS ID 742170

History of Changes from the VAERS Wayback Machine

First Appeared on 7/14/2018

VAERS ID: 742170
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2018-02-19
Onset:2018-02-26
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-02-26
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: 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.


Changed on 8/14/2018

VAERS ID: 742170 Before After
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2018-02-19
Onset:2018-02-26
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-02-26
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: 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.


Changed on 9/14/2018

VAERS ID: 742170 Before After
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2018-02-19
Onset:2018-02-26
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-02-26
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: 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.


Changed on 10/14/2018

VAERS ID: 742170 Before After
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2018-02-19
Onset:2018-02-26
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-02-26
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: 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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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=742170&WAYBACKHISTORY=ON


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