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From the 10/15/2021 release of VAERS data:

Found 2,931 cases where Patient Died and Vaccination Date from '2010-01-01' to '2020-12-31'



Case Details

This is page 13 out of 294

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VAERS ID: 418868 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Montana  
Vaccinated:2011-02-10
Onset:2011-02-10
   Days after vaccination:0
Submitted: 2011-03-16
   Days after onset:33
Entered: 2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2011-02-20
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


VAERS ID: 418984 (history)  
Form: Version 1.0  
Age: 0.21  
Sex: Female  
Location: Virginia  
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted: 2011-03-11
Entered: 2011-03-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Death, Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-02-23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS.


VAERS ID: 419371 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Illinois  
Vaccinated:2011-03-16
Onset:2011-03-17
   Days after vaccination:1
Submitted: 2011-03-23
   Days after onset:6
Entered: 2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 3 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-03-17
   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: none
Current Illness: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


VAERS ID: 419564 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Vermont  
Vaccinated:2011-02-07
Onset:0000-00-00
Submitted: 2011-03-25
Entered: 2011-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B172AA / 1 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1272Z / 1 RA / UN

Administered by: Private       Purchased by: Public
Symptoms: Condition aggravated, Death, Epilepsy, Status epilepticus, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-02-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B; LAMICTAL; KEPPRA; TOPAMAX
Current Illness: None
Preexisting Conditions: Epilepsy; Right hemiparesis; GERD; Strabismus; Cerebral Palsy
Allergies:
Diagnostic Lab Data: Known left middle cerebral artery infarct with right hemiplegia and epilepsy.
CDC Split Type:

Write-up: DTaP/IPV and VARIVAX given at 14:30 on 2/7/11 as health care maintenance. Patient found unresponsive with vomit in bed around 6 am on 2/8/11. Pronounced deceased on arrival to the ED on 2/8/11. Presumed cause of death is status epilepticus in this patient with known and worsening epilepsy. Medical Examiner involved, and no autopsy performed.


VAERS ID: 420013 (history)  
Form: Version 1.0  
Age: 0.84  
Sex: Male  
Location: Unknown  
Vaccinated:2010-10-12
Onset:2011-03-15
   Days after vaccination:154
Submitted: 2011-03-30
   Days after onset:15
Entered: 2011-03-31
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C368AA / 2 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3575DA / 1 UN / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB24CA / 3 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 914274 / 2 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Autopsy, Cardiac arrest, Cardiomegaly, Convulsion, Culture tissue specimen positive, Death, Meningitis pneumococcal, Neurological infection, Pyrexia, Viral myocarditis, Vomiting, X-ray abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-03-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray (14-MAR-2011) results: showed he had an enlarged heart; Autopsy - brain tissue culture (15Mar2011) revealed: pneumococcal meningitis
CDC Split Type: 2011066068

Write-up: This is a spontaneous report from a Pfizer sales representative on behalf of a contactable physician. A 15-month-old male (at the time of death) received the first dose of PREVNAR 13 on an unknown date in JUL2010 at 0.5ml, and the second dose on an unknown date in Oct2010, to prevent against pneumococcal disease. Relevant medical history was unknown. The relevant concomitant medications were unknown. The infant had only been administered two doses of PREVNAR 13 instead of four doses. On 11MAR2011, he was taken to the Emergency Room and diagnosed with neural infection. Treatment was not reported. On 13MAR2011, the patient was taken to the Emergency Room again, but did not see the doctor came back home. On 14MAR2011, the patient was taken to the physician''s office, where he presented with fever, vomiting, and neural infection, because of which he was hospitalized. On 14MAR2011, while in the hospital, he had seizures. An x-ray was performed which revealed an enlarged heart. The patient then had cardiac arrest. On 14MAR2011, the patient was transferred to a hospital where they have found viral myocarditis. Treatments in response to the events were not reported. On 15MAR2011, the infant died. An autopsy was performed on brain tissue culture on 15MAR2011, which showed that he died due to pneumococcal meningitis. The clinical outcome of the reported event of pneumococcal meningitis (per autopsy results) was fatal, and the outcome of the other events was unknown. Based on the information provided in the case, this individual report would not seem to modify the benefit/risk profile of PREVNAR 13.


VAERS ID: 420044 (history)  
Form: Version 1.0  
Age: 0.33  
Sex: Male  
Location: Unknown  
Vaccinated:2010-04-30
Onset:2010-05-13
   Days after vaccination:13
Submitted: 2011-02-14
   Days after onset:277
Entered: 2011-03-31
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3139A / 1 UN / IJ
HIBV: HIB (ACTHIB) / SANOFI PASTEUR D0870 / 1 UN / IJ
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0304 / 1 UN / IJ
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E15306 / 1 UN / IJ

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal distension, Acquired diaphragmatic eventration, Aerophagia, Autopsy, Bronchopulmonary dysplasia, Cardiac output decreased, Cardiopulmonary failure, Cardiovascular disorder, Condition aggravated, Crying, Death, Flatulence, Gastrointestinal oedema, Hypoxia, Inguinal hernia, obstructive, Intestinal haemorrhage, Intra-abdominal pressure increased, Pulmonary arteriopathy, Pulmonary hypertension, Renal impairment, Respiratory disorder, Resuscitation, Right ventricular hypertrophy, Unresponsive to stimuli, Vascular resistance systemic increased, Venous insufficiency
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The subject, according to the autopsy report, had a medical history which included premature birth (25 weeks gestation) with intrauterine growth restriction (395 g birth weight) ascribed to maternal chronic hypertension with super-imposed pre-eclampsia/atypical HELLP syndrome. The infant had a prolonged hospital course with morbidity including respiratory distress with apnea, retinopathy, patency of the ductus arteriosis with attempted surgical closure, right ventricular hypertrophy, pulmonary hypertension, hepatic dysfunction and metabolic derangements, and inguinal and umbilical hernias. The infant was discharged to home n 9 May 2010 at a "corrected" gestational age of 42.5 weeks. Repair of his inguinal hernias was planned for around 50 weeks corrected age. The patient received dose 1 of PEDIARIX on 07 March 2010, lot number AC21B208BA.
Allergies:
Diagnostic Lab Data: Not reported
CDC Split Type: 201005539

Write-up: Initial report received on 28 September 2010 from an investigator participating in a study under the reference number M5A11. An infant male subject who born with an incarcerated inguinal hernia on 29 December 2009. The investigator reported that at 4 months of age the infant received the following vaccines on 30 April 2010: first injection of DAPTACEL, lot number C3139AA; first injection site of ACTHIB, lot number D0870 (UF739AA); first injection of IPOL, lot number D0304; and first injection of pneumococcal vaccine (PNCV7), Wyeth, lot number E15306; and died 15 days post-vaccination. According to the autopsy report, the infant''s medical history included premature birth (25 weeks gestation) with intrauterine growth restriction (395 g birth weight) ascribed to maternal chronic hypertension with super-imposed pre-eclampsia/atypical HELLP syndrome. The infant had a prolonged hospital course with morbidity including respiratory distress with apnea, retinopathy, patency of the ductus arteriosis with attempted surgical closure, hepatic dysfunction and metabolic derangements, and inguinal and umbilical hernias. The infant was discharged to home on 9 May 2010 at a "corrected" gestational age of 42.5 weeks. Repair of his inguinal hernias was planned for around 50 weeks corrected age. On 13 May 2010, the infant became unresponsive following a period of inconsolable crying after a feeding. He could not be resuscitated despite efforts by parents, EMS, and attendings in the ED. The most striking finding in the ED and at autopsy was massive abdominal distension that was not relieved by removal of copious milk from the stomach via NG tube. The large volume of air in the highly distended intestine was sufficient to elevate the diaphragm and increase the intra-abdominal pressure; thus predisposing the infant to reduced cardiac output, increased renal and systemic vascular resistance, decreased venous return to the heart, reduced visceral blood flow, and altered respiratory dynamics. The origin of the intestinal air was most likely a combination of vigorous crying and resuscitative efforts (which included 10 minutes of bag-mask ventilation). Hypertrophy of the right ventricle and pulmonary arterial changes further predisposed him to hypoxia and low cardiac output if venous return were reduced. Obstruction of the terminal ileum in the hernia would be worsened by the intra-abdominal pressure, which would prevent egress of intra-intestinal air. Autopsy internal examination found right inguinal hernia contains 8 cm loop of congested dilated edematous distal-most ileum, along with its hemorrhagic appearing mesentery. There is egress of approximately 10 cc blood tinged clear fluid when the right hernia is reduced (with difficulty). The left hernia contains 8 cm loop of sigmoid colon, which is mildly edematous and mildly dusky and relatively easily reduced. Death was considered multifactorial: acute incarceration of right inguinal hernia, with crying, swallowing of air, and abdominal distension resulting in cardiorespiratory compromise against a background of chronic lung disease with pulmonary hypertension and right ventricular hypertrophy. According to the investigator, the event was not related to the study vaccine. Follow-up information was received on 14 October 2010 from a investigator participating in a trial under the reference number M5A11. The start date of the SAE was changed to the probable date of aggravation of congenital condition (incarceration of inguinal hernia). The start date for the incarcerated inguinal hernia was changed to 13 May 2010 (previously reported as 29 December 2009). According to the investigator, the event remained not related to the study vaccine. Documents held by sender: Autopsy report.


VAERS ID: 420242 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Female  
Location: New Jersey  
Vaccinated:2011-02-25
Onset:2011-03-05
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2011-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1510Z / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 91497Z / 4 UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1321Z / 1 UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Death, Lethargy, Nasopharyngitis, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-03-05
   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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her shots on Feb 25, 2011. On Thursday March 3rd patient seemed like she was coming down with a cold. We bathed her and she ended up throwing up what little food she ate for dinner. On Friday March 4th patient seemed OK during the day according to her daycare, but at home that night she seemed lethargic and was running a 100.4 fever. Was given a little infants ADVIL and was put to bed at 8:15pm, checked her at 10:15pm, and then at 3:15 am when she had already passed in her sleep.


VAERS ID: 420337 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Male  
Location: Florida  
Vaccinated:2011-03-30
Onset:2011-03-31
   Days after vaccination:1
Submitted: 2011-04-05
   Days after onset:5
Entered: 2011-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B256CA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH254AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1074Z / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cold sweat, Death, Hypophagia, Hypotonia, Respiratory arrest, Skin warm, Somnolence, Yellow skin
SMQs:, Cholestasis and jaundice of hepatic origin (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-03-31
   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: none
Current Illness: well baby
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4-1-2011 mother presents to clinic requesting child, immunization record. Mother reports that her baby died 3-31-2011 at approximately 10:50 am. She reports the following: On 3-30-11 at 12:30pm she brought patient to the CHD for a routine well baby visit and immunizations. The child was done with the visit and receiving his shots by about 1pm. The rest of the day the child was sleepy and ate about 2 oz of formula vs his normal 7 oz at a time. At 11:30 pm she performed his routine diaper change and feeding. At that time he was moist to touch, but not running a fever (she never took his temperature but he felt warm to touch). 3-31-11 2AM; the baby accompanied the family to the ER for another child''s scraped knee. They returned at 4AM, in which the mother reports she fed the baby 2 oz and did a diaper change. 10:40 AM the mother woke up and checked the baby, the baby was sleeping on his stomach. She reports that she does not believe in putting the baby on his back, because she thinks the baby will choke, she admits that she was trained by the provider, he should be on his back for sleeping. She then went out to the garage to have a cigarette. She returned at 10:50 am to get the baby up. The babies arm was flopped out and looked yellow, she checked the baby for breathing, and he was not breathing, then called 911. I gave the mother a copy of the child''s immunization record. Offered Healthy Start bereavement services, she declined, stating she has enough family support for that.


VAERS ID: 420445 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2010-04-01
Onset:2010-04-01
   Days after vaccination:0
Submitted: 2011-04-06
   Days after onset:370
Entered: 2011-04-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Death, Herpes simplex, Herpes zoster, Simplex virus test positive
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-12-01
   Days after onset: 244
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hydrocortisone
Current Illness: Leukopenia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: herpes simplex virus, Confirmed it was the oka strain
CDC Split Type: WAES1103USA03961

Write-up: Information has been received from a physician concerning a 75 year old male with "chronic leukopenia" who in April 2010, was vaccinated with a dose of ZOSTAVAX (Merck) (lot # not reported). Concomitant therapy included hydrocortisone (manufacturer unknown). In May 2010, the patient developed shingles spread to his face. In October 2010, the patient was admitted to hospital with dissemination. Acyclovir IV was given for two weeks then Acyclovir oral for 2 weeks for the treatment of the adverse event. In December 2010, the patient was admitted again to the hospital and died three weeks later. On unspecified date, lab study was performed on the ZOSTAVAX (Merck) which confirmed it was the oka strain. Additional information has been requested.


VAERS ID: 421048 (history)  
Form: Version 1.0  
Age: 1.51  
Sex: Female  
Location: California  
Vaccinated:2010-10-15
Onset:2010-11-08
   Days after vaccination:24
Submitted: 2011-04-14
   Days after onset:156
Entered: 2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-11-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC Split Type:

Write-up: Sudden unexplained death.


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