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This is VAERS ID 831139

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2020

VAERS ID: 831139
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2019-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER VNS1S12D / UNK - / -
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH W19703 / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: Comments: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ESPFIZER INC2019354059

Write-up: death; This is a spontaneous report from a contactable Other Health Professional from the local Regulatory Authority (Regulatory Authority ES-AEMPS-533524). A 4-month-old male patient received meningococcal group C tetanus toxoid conjugate vaccine (NEISVAC-C, lot#: VNS1S12D) and pneumococcal 13-valent conjugated vaccine (dipht crm197 protein) (PREVENAR 13, lot#: W19703), both via an unspecified route of administration on an unspecified date at single dose for vaccination, and diphtheria vaccine toxoid, hepatitis b vaccine rhbsag (yeast), hib vaccine conj, pertussis vaccine acellular 3-component, polio vaccine inact 3v (vero), tetanus vaccine toxoid (INFANRIX HEXA, lot#: A21CD077A), via an unspecified route of administration on an unspecified date at unspecified dose for vaccination. The patient had no relevant medical history. The patient''s concomitant medications were not reported. The patient experienced death on an unspecified date the night after vaccination. An autopsy was performed and results were not provided.; Reported Cause(s) of Death: death

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