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VAERS ID: 1000274

AGE: UNK| SEX: M|State: FR

Description

Tingling of extremity; Paresthesia of limbs; Hypoesthesia; Information has been downloaded(FR-AFSSAPS-BR20210016). This spontaneous report was received from a physician referring to a 75-year-old male patient. The patient's concurrent conditions included hyperplastic polyp of large intestine, sleep apnea syndrome and ischaemic heart disease. The patient's medical history included peripheral artery bypass (femoro popliteal on 10-NOV-2008), peripheral arterial occlusive disease (iliofemoral endarterectomy and iliac dilatation on 26-NOV-2012) and coronary artery bypass (triple bypass in 2008). On 12-NOV-2020, the patient was vaccinated with influenza virus sag 4v vaccine inactivated(INFLUVAC TETRA) (lot # X39, 1 dosage form, intramuscular; expiration date not reported) for flu vaccination. On 18-NOV-2020, the patient was vaccinated with pneumococcal vaccine, polyvalent (23-valent) (PNEUMOVAX) (lot # T018800, expiration date not reported, upon internal validation established as 30-JUN-2022, 1 dosage form, intramuscular) for prophylactic vaccination. On 23-DEC-2020, the patient experienced tingling of extremity, paresthesia of limbs and hypoesthesia. The patient was hospitalized due to the events on an unknown date. The outcome of the events was reported as recovering. The causality assessment was not reported. combinationproductreport: Yes; brandname: PNEUMOVAX23 SYRINGE (DEVICE); commondevicename: Pneumococcal Vaccine, Polyvalent (23-valent); productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp. expirationdate: 30-JUN-2022; deviceage and unit: 0 ; malfunction: Unknown; deviceusage: Initial; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not suggest a causal association with the device or device constituent

Symptoms

Hypoaesthesia, Paraesthesia

Vaccines

VAX DATE: 11 November 2020 | ONSET DATE: 22 December 2020 | DAYS TO ONSET: 41
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • FLUX
  • PPV
  • UNK
  • MERCK & CO. INC.
  • UNKNOWN MANUFACTURER
  • INFLUENZA (SEASONAL) (NO BRAND NAME)
  • PNEUMO (PNEUMOVAX)
  • VACCINE NOT SPECIFIED (NO BRAND NAME)
  • UNK
  • OT
  • T018800
  • X39

RECVDATE:
03 February 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
Y
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
N
LAB_DATA:
V_ADMINBY:
UNK
OTHER_MEDS:
CUR_ILL:
Flu vaccination; Prophylactic vaccination
HISTORY:
Medical History/Concurrent Conditions: Coronary bypass (triple bypass in 2008); Femoral artery bypass (femoro popliteal on 10-NOV-2008); Hyperplastic polyp of large intestine; Ischaemic heart disease; Peripheral arterial occlusive disease (iliofemoral endarterectomy + iliac dilatation on 26-NOV-2012); Sleep apnea syndrome
PRIOR_VAX:
SPLTTYPE:
FR0095075132101FRA013704
FORM_VERS:
2
TODAYS_DATE:
02 February 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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