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From the 10/8/2021 release of VAERS data:

Found 3,102 cases where Patient Died and Vaccination Date from '2007-08-01' to '2020-11-30'



Case Details

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VAERS ID: 330558 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Male  
Location: Maine  
Vaccinated:2008-10-13
Onset:2008-10-25
   Days after vaccination:12
Submitted: 2008-10-27
   Days after onset:2
Entered: 2008-10-29
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500536P / UNK NS / IN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blood alkaline phosphatase normal, Blood potassium increased, Blood sodium increased, Eosinophil count increased, Lymphocyte count increased, Neutrophil count decreased, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-10-25
   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: 11/3/08-records received-completed prednisone taper day prior after Flumist.
Preexisting Conditions: Asthma, Nuts 11/3/08-records received- PMH-Multiple allergies. Asthma. Lung disease.
Allergies:
Diagnostic Lab Data: K, 5.2; Na, 150; Cl, 108; Alk phos, 157; Lymp, 45.3; Neut, 35; EOS, 10
CDC Split Type:

Write-up: 515 Child not breathing at home - brought to ED by POV. 525 Arrived in ED, full arrest at that time. Vitals monitor. 0544 ETT placed, Epi. 11/3/08-records received from ED for DOS 10/25/08-presented to ED dyspnea, unresponsive ventricular fibrillation. At home acutely SOB 6/23/09-death certficate and autopsy report received-COD Status asthmaticus. Lymphocytic bronchitis.


VAERS ID: 331269 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Male  
Location: Maryland  
Vaccinated:2008-10-21
Onset:2008-10-22
   Days after vaccination:1
Submitted: 2008-11-04
   Days after onset:13
Entered: 2008-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA181AA / UNK RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Malaise, Mechanical ventilation, Pneumonia
SMQs:, Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2008-11-13
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Multivitmin
Current Illness: Upper respiratory symptoms, fatigue
Preexisting Conditions: HX OF MACROCYTIC ANEMIA/1988/SEEN BY HEMATOLOGIST 2002/WAS TO HAVE BONE MARROW BX HX OF SMOKING/1 PPD X 44 YEARS/WEARING PATCH HX OF (L) HIP PAIN ASSOCIATED WITH PRIOR TORN LIGAMENT WHICH HAS CALCIFIED/S/P PT AND CORTISONE INJECTIONS #2 2001 HX OF FATIGUE WEARS H/F RESPIRATOR APPROX. 2 X PER YEAR WHEN WORKING WITH AIRHANDLER''S EXHAUST FUMES HX OF LOW HDL''S S/P LUMBAR LAMINECTOMIES 3/25/03 (L3,4,5) S/P THORACIC NERVE PROBLEM 12/03/SENT FOR MRI/DDD AND SPURS FOUND/SEES PT 2 X PER WEEK (1 1/2 MONTHS)/WILL CONTINUE WITH HOME EXERCISES Quit smoking entirely 12/2005 Full cardiac workup in 2006 including Cardiolyte Stress Test - normal, CXR. Workup done d/t mild intermittent chest symptoms, fatigue PMH: COPD, DM type 2, GERD, spinal stenosis s/p laminectomy, squamous cell carcinaoma of ear. NKDA
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Chest CT (+) for opacity superimposed on severe pulmonary fibrosis, later (+) for PE. Doppler (+) for DVT. Head CT (-). HIT antibody (+). Bonchoscopy (+) for diffuse alveolar hemorrhage and severe pulmonary fibrosis. CT abd/pelvis suggestive of inflammatory or infectious colitis.
CDC Split Type:

Write-up: Employee presented in the occupational Health clinic on 10/21/08 for a influenza vaccination. He told the RN that he had a mild URI illness but no fever and he consented to getting Flulaval after a brief discussion about postponing it until he felt well. The following day he was admitted to Hospital from home with possible pneumonia. Within days he was transferred by helicopter to Medical System where he remains in treatment. The information we have comes via his supervisor. He is reportedly on a ventilator and receiving steroids. We have provided the hospital with the employee medical record. 12/22/2008 MR received for DOS 10/24-11/13/2008 with D/C DX: Acute interstitial pneumonitis, respiratory failure, pulmonary embolism, acute renal failure and death. Pt transferred from local hospital (admitted 10/22/08)for hypoxemic respiratory failure following 6 months of progressive dyspnea and evaluation for lung transplant. On admission T=96.5''F, intubated and sedated with O2 sat of 96%, coarse bilateral breath sounds and tachycardic. Tx for pneumonia but developed DVT with PE which was symptomatic on 11/10/08. Started on heparin but unable to be aroused from sedation. Platelet count dropped. Pt suffered a PEA arrest on 11/13/08 with restoration of BP and heartrate with CPR however BP difficult to maintain despite high dose pressors. Life support withdrawn and pt died at 10:41 on 11/13/08. Autopsy reports COD as Pulmonary Fibrosis due to a combination of acute pneumonia and organizing diffuse alveolar damage superimposed on a background of chronic interstitial lung disease and emphysema.


VAERS ID: 331589 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Nebraska  
Vaccinated:2008-11-04
Onset:2008-11-05
   Days after vaccination:1
Submitted: 2008-11-06
   Days after onset:1
Entered: 2008-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2955BA / 2 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR AU836 / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C80901 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0502X / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Autopsy, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-11-05
   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: None
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Autopsy (P)
CDC Split Type:

Write-up: Pt. was found dead in the crib at daycare the following afternoon. 2/18/09-autopsy report received-COD Sudden Infant Death Syndrome.


VAERS ID: 331645 (history)  
Form: Version 1.0  
Age: 56.0  
Sex: Female  
Location: Ohio  
Vaccinated:2008-10-21
Onset:0000-00-00
Submitted: 2008-11-03
Entered: 2008-11-07
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2997AA / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Death, Upper respiratory tract infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-10-30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown PMH: insomnia, OA, myalgia/fibromyalgia, sinusitis, depression, postmenopause. Allergy: penicillin & sulfa.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Course of illness prior to death unknown. Aware she did have URI and could not attend school. 1/27/09 Autopsy report states COD as acute bronchopneumonia due to acute intoxication by hydrocodone. Also states additional anatomic dx: mod hepatocellular fatty metamorphosis & early postmortem decomposition. 11/11/08 Reviewed PCP medical records of 10/27/2008. FINAL DX:COPD, cough, acute rhinitis, chronic sinusitis Records reveal patient experienced cough & body pain, no fever. Dx w/COPD & acute bronchitis. Tx w/antibiotics & cough med.


VAERS ID: 332724 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Female  
Location: Utah  
Vaccinated:2008-10-23
Onset:2008-10-23
   Days after vaccination:0
Submitted: 2008-11-18
   Days after onset:26
Entered: 2008-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2805AA / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Hypersensitivity, Oedema peripheral, Rash, Vasculitis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-11-13
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: liptor, spironolactone, lanoxin, allopurinol, macrobid, plaquinil, hydrochlorthiazide, quinapril
Current Illness:
Preexisting Conditions: Rheumatoid arthritis, osteoperois, gout, chronic UTI, hyperlipid, chf. 12/29/08-records received-PMH: rheumatoid arthritis. status post mitral valvle replacement. status post left mastectomy for breast cancer. chronic UTI. osteoporosis.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: she presneted 10/23 for a blood pressure check up and in the course of that we did an annual flu shot for her. See the flu shot note: 10/23/08 The following questions were answered by the patient: Are you currently ill with a moderate or severe illness? No Temperature: __ Are you allergic to eggs or egg products? No Have you ever been paralyzed by Guillain Barre Syndrome? No Have you ever had a severe allergic reaction after getting the flu vaccine? (difficulty breathing, aiway swelling, hives, etc.) No Patient was given the opportunity to ask questions prior to immunization and have them answered to their satisfaction: _Yes Manufacturer: Aventis Lot #: U2805AA Expiration Date: 06/30/2009 Preservative Free _No Vaccine information sheet given: Yes VIS Pub. Date: 07/24/08 Dose: 0.5 ml Site: left deltoid She then reproted on 10/31 with swelling in hands and feet and rash. It looked like allergic reaction. she was not ill so we treated her as an out patient. she called a few days later and was getting worse. I had her admitted to hospital. I have not received a formal report. One of the diagnosis that was on the top of the list was influenza vaccine vasculitis. she was not getting better. The Dr. that was caring for her reported that her dau, a hospice nurse talked to her about what was going on and patient decieded to not have any more needle pokes or evaluation. She was sent to nursing home and died the next day. 12/29/08-records received for DOS 11/3-11/12/08-DC DX: likely vasculitis. acute renal failure, resolving. Presented with C/O weakness, seen 3 days prior with swelling in fingertips and lower extremities. Hyperkalemic. Dehydrated. Hyponatremia. Purpura of feet and lower extremities. 11/21/08 Death certificate states COD as acute renal failure with vasculitis & immunologic reaction as contributing factors.


VAERS ID: 333075 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:2008-11-12
Onset:2008-11-14
   Days after vaccination:2
Submitted: 2008-11-20
   Days after onset:6
Entered: 2008-11-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C94097 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0310X / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dehydration
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-12-08
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None Noted
Preexisting Conditions: Unknown PMH: Family hx epilepsy, liver & kidney disease, DM.
Allergies:
Diagnostic Lab Data: LABS: Head CT & MRI c/w significant cerebral edema.EEG abnormal. Rhinovirus, EBV, CMV IgG & adenovirus c/s (+). CXR abnormal. Abdominal US abnormal. LABS: CO2 11.0(L); calcium 7.4(L); protein 4.1(L); bilirubin total 2.3(L); AST 22,409(H); ALT 11,903(H); alk phos 436(H). Lactic acid 6.4(H); ammonia 232(H). WBC 5.2(L), H/H 6.8/18.8(L), plts 95(L), segs 69%(H), lymphs 20%(L). CRP <0.5. PT $g100(H), PTT 12.6(H), fibrinogen 65(L), INR 12.6. UA w/large amount blood, protein $g300. CXR revealed pulmonary edema & ascites. Echocardiogram WNL. CT head WNL. Abdominal US abnormal & revealed ascites w/pericholecystic fluid. Blood, urine c/s neg.
CDC Split Type:

Write-up: It was reported that infant was taken to local clinic on 11-14-08 and seen by a private physician. It was reported that the infant had been vomiting and was dehydrated, no fever. Infant was treated and sent home. Infant returned to local ER on 11-15-08 and was transferred to hospital. From there infant was transferred to another hospital. 1/12/09 Death certificate states COD as Liver failure & trisomy 21. 1/12/09 Reviewed hospital medical records of 12/3-12/8/2008. FINAL DX: severe metabolic syndrome including trisomy 21, renal failure, kidney failure, coagulopathy & cerebral edema. Records reveal patient had steady downhill course after transfer & expired 12/8/08. Death certificate included w/medical records. 1/7/09 reviewed hospital medical records of 11/16-12/2/2008. FINAL DX: idiopathic fulminant hepatic failure; multiorgan failure including liver & kidney''s; encephalopathy; coagulopathy. Records reveal patient experienced vomiting day after vaccinations then irritable & continued vomiting next day & became lethargic. Family tx w/Tylenol in correct dosing regimen. Unable to tolerate feedings & taken to outlying hospital ER on 11/14. Dx w/seizure & glucose of 15. Tx & transferred to outlying hospital. Glucose & liver enzymes remained high. Dx w/fulminant hepatic failure, anemia & coagulopathy. Tx w/IVF, insulin drip, PRBCs & blood products. Developed respiratory failure & was intubated. Transferred to higher level of care. On admission had anasarca, jaundice & elevated ammonia. TPN & continuous venovenous hemodialysis started. GI, metabolic, neuro consults done. Mitochondrial disorder suspected. Liver & right thigh muscle biopsy revealed metabolic disorder & necrosis. Deemed not a candidate for transplant. Dialysis stopped, extubated & transferred as DNR to hospital closer to family. 12/5/08 Received hospital medical records of 11/16-12/2/08 which consisted only of operative report & labs. Operative report indicates patient w/fulminant hepatic failure, coagulopathy, renal failure, cerebral edema & gen weakness. Had open liver biopsy & left thigh muscle biopsy on 11/24/08. 12/2/08 Reviewed hospital medical records of 11/15/2008. FINAL DX: no d/c summary available; H&P states respiratory failure, anemia & severe metabolic acidosis; severe coagulopathy. Records reveal patient experienced projectile vomiting, weakness, lethargy x 4 day. Seen in outlying ER, dx w/dehydration & tx w/oral rehydration. Worsened w/increased weakness, diet refusal, moaning & returned to same ER. Seizure noted in ER at that time secondary to hypoglycemia (BS=15) then rebound hyperglycemia (BS$g500). Transferred to higer level of care for PICU. Intubated on arrival, pale, tachycardic, chest retractions, abdominal distention & tenderness, decreased BS, NGT w/bloody & coffee grounds aspirate, hypotonia, areflexic. Transfused PRBCs & FFP. Tx w/antibiotics. Transferred to higher level of care.


VAERS ID: 333284 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Male  
Location: Florida  
Vaccinated:2008-11-06
Onset:2008-11-13
   Days after vaccination:7
Submitted: 2008-11-25
   Days after onset:12
Entered: 2008-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLLA209AA / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Confusional state, Disorientation, Encephalitis, Intensive care
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2008-12-20
   Days after onset: 37
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 37 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Cozaar, Lipitor, Flomax
Current Illness: None
Preexisting Conditions: Hypertension, hyperlipidemia, benign prostatic hypertrophy PMH: obesity, kidney stones,
Allergies:
Diagnostic Lab Data: LABS: Brain biopsy. CSF: WBC 141( H), lprotein 135(H), glucose 161(H), c/s (+) strep grp B & S. simulu. Initial CT brain scan, MRI brain & CXR WNL. Later CT brain revealed bilateral SDHs. Paracentesis fluid: WBC 1822(H), lymphs 5%(H), polys 95%(H), c/s (+) candida. CBC, ammonia, B12, folic acid, ESR, TSH WNL. LFTs (H). Sodium 133. UA abnormal. Blood c/s (+)E.faecal, E. coli, S. Eeider, candida. Urine c/s (+) E. coli & candida. Sputum c/s(+) psuedomonas & Strep Grp B. EEG c/w diffuse encephalopathy, no seizures. CT abdomen & renal US (+) multiple nonobstructing bladder & kidney stones. US doppler of LEs neg.
CDC Split Type:

Write-up: Started with confusion and disorientation abou 3-4 days afterwards which developed into a full bown encephalitis. Presently in an intensive care unit at Medical Center. 1/6/09 Received hospital medical records of 11/13/08-12/20/2008 FINAL DX: No d/c summary dictated. Consults mention multisystem organ failure, fever, cellulitis, UTI, acute renal failure, syncope Records reveal patient being treated for UTI x approx 1 week. Developed confusion, weakness, malaise, dizziness, fever, fall w/amnesia, lethargy, rash mostly over LEs. Fever 101.5 in ER. ID, Neuro, Uro, Nephro, Pulmo, Heme consults done. Developed diabetes, dysphagia, hypernatremia, drug induced thrombocytopenia, liver encephalitis, polymicrobial sepsis w/feeding tube disruption, intra-abdominal infection & acute respiratory distress. Admitted ICU & intubated. LP done. Tx w/IV antibiotics, antivirals, antiseizure meds, steroids, PEG tube feeding, plasmapheresis, dialysis. Continued downhill course & transferred to hospice on 12/20/08.


VAERS ID: 333759 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2008-11-21
Onset:2008-11-26
   Days after vaccination:5
Submitted: 2008-11-28
   Days after onset:2
Entered: 2008-12-03
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B198AA / 3 LL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U22787CA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 09688 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Death
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-11-26
   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: Zantac
Current Illness: Minimal URI
Preexisting Conditions: "Snoring" per ENT; No sleep apnea; GERD 3/9/09-records received-per parent patient suffered from sleep apnea from birth and sometimes snore when sleeping. Antibiotic therapy for recent throat problem. Born 4 weeks premature.
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 5 days after vaccines administered pt was found face-down in crib not breathing. Resuscitation not successful. No other signs of illness. Presumed SIDS vs suffocation. 3/9/09-autopsy report received-COD Sudden Infant Death Syndrome.


VAERS ID: 334041 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Colorado  
Vaccinated:2008-10-02
Onset:2008-10-28
   Days after vaccination:26
Submitted: 2008-12-04
   Days after onset:37
Entered: 2008-12-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR - / 3 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05881 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Antibody test positive, Apnoea, Band neutrophil percentage, Blood culture positive, Body temperature increased, Bradycardia, Brain scan abnormal, CSF culture positive, Cerebral infarction, Chest X-ray normal, Convulsion, Culture negative, Culture urine negative, Death, Decreased appetite, Endotracheal intubation, Gram stain positive, Head circumference normal, Lymphocyte percentage, Meningitis pneumococcal, Monocyte percentage, Neutrophil percentage, Pneumococcal bacteraemia, Pupil fixed, Pyrexia, Red blood cell sedimentation rate increased, Respiratory disorder, Subdural effusion, White blood cell count increased
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vasculitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-11-14
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: Unknown
Preexisting Conditions: Premature Baby 33 to 36 weeks
Allergies:
Diagnostic Lab Data: Antibody test, 11/05/2008, Anti-T antibodies - positive; Band neutrophil percentage, 10/28/2008, 6%; Blood culture, 10/28/2008, Strep pneumo; Body temperature, 10/27/2008, 101.8 deg. F, 11/05/2008, 97.9 deg. F; CSF culture, 10/28/2008, pneumococcus (Gram stain many G+ cocci in chains); Chest X-ray, 10/27/2008, Normal chest; Culture, 11/05/2008, fluid from subdural effusions - negative; Culture urine, 10/27/2008, no organisms; Lymphocyte percentage, 10/28/2008, 26%; Monocyte percentage, 10/28/2008, 4%; Neutrophil percentage, 10/28/2008, 64%; Physical examination, 10/02/2008, Weight - 17 lb, 6-1/2 inches.; height - 27-3/4 inches; head circumference, 47.5 cm; language/speech, emotional/social, fine/gross motor skills, cognitive thinking, physical growth, developmental milestones - all normal range; Red blood cell sedimentation rate, 10/27/2008, 72; Scan brain, 11/03/2008, stable mild diffuse ventriculomegaly, bilateral subdural collections with the left larger than right, and signal abnormality within the brains as above, compared to MRI performed two days ago; multi-focal infarcts, mild ventriculomegaly, and bilateral subdural fluid collections that stable in comparison to a 03/11/2008 scan.; White blood cell count, 10/28/2008, 5.8; 10/31.2008, 21.9; 11/05/2008, 10.0; Reported Cause of Death, Meningitis pneumococcal, Streptococcus pneumoniae meningitis
CDC Split Type: USWYEH06608908

Write-up: Additional information was received that provided patient details, medical history, concomitant therapy, laboratory results, event details including updated and additional events, and a fatal outcome. Information regarding PREVENAR was received from a healthcare professional regarding a 6-month-old female patient who received a third dose on 02-OCT-2008 along with a third dose of ACT-HIB (Aventis), a third dose of TRIPEDIA (Aventis), and third dose of ROTATEQ (Merck & Co Inc) and experienced pneumocococcal bacteremia, Streptococcus pneumoniae meningitis, apnea requiring intubation, multiple infarcts of brain, bradycardia and fluid collection around the brain. The patient has a past history of being a premature baby (36 weeks) (delivered by cesarean section, was in the neonatal intensive care for 2 days). Has a twin. Concomitant therapy included ACT-HIB, TRIPEDIA, ROTATEQ and Zantac. On 20-OCT-2008, the patient was hospitalized after a brief history of several days with respiratory symptoms, low grade fever and decreased appetite and was diagnosed with meningitis pneumococcal and pneumococcal bacteraemia. A blood and cerebrospinal fluid culture was performed showing Streptococcus pneumoniae (serotype not reported). Treatment included KEFLEX, dexamethasone, vancomycin, rifampin, ceftriaxone, Cefotaxime and mannitol. During the course of hospitalization, additional laboratory tests and brain scans were performed which showed multi-focal infarcts with bilateral subdural fluid collections. Initially, the patient''s clinical condition stabilized but then was complicated by seizures, apnea requiring intubation, multiple cerebral infarction with subdural effusion and bradycardia. As of 05-Nov-2008, a hospital record indicated the patient''s pupils were fixed and dilated. On 14-NOV-2008, it was reported that the patient died. The cause of death was reported as meningitis pneumococcal. Physical examination (results: Weight-17 lb, 6-1/2 inches, height-27-3/4 inches, head circumference 47.5 cm, language/speech, emotional/social, fine/gross motor skills, cognitive thinking, physical growth, developmental milestones - all normal range was done on 02-Oct-2008. On 27-Oct-2008 test results were: chest X-ray (results: Normal chest); red blood cell sedimentation rate (results:72); body temperature (results: 101.8 deg. F.); and culture urine (results: no organisms). On 28-Oct-2008 test results were neutrophil percentage (results: 64%); Band neutrophil percentage (results: 6%); blood culture (results: Strep pneumo); white blood count (results: 5.8); CSF culture (results: pneumococcus (Gram stain stain many G+ cocci in chains)); monocyte percentage (results: 4%); and lymphocyte percentage (results: 26%). White blood cell count (results: 21.9) and scan brain (results: stable extra-axial fluid collections) were done on 31-Oct-2008. Scan brain (results: stable mild diffuse ventriculomegaly, bilateral subdural collections with the left larger than the right, and signal abnormality within the brain as above, compared to MRI performed two days ago) was done on 03-Nov-2008. On 05-Nov-2008 test results were: body temperature (results: 97.9 deg. F.); scan brain (results: multi-focal infarcts, mild ventriculomegaly, and bilateral subdural fluid collections - stable in comparison to a 03-Nov-2008 scan.); white blood cell count (results: 10.0); antibody test (results: Anti - T antibodies - positive); and culture (results: fluid from subdural effusions - negative). No additional information was available at the time of this report.


VAERS ID: 334270 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Male  
Location: California  
Vaccinated:2008-10-29
Onset:2008-11-14
   Days after vaccination:16
Submitted: 2008-12-03
   Days after onset:19
Entered: 2008-12-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dyspnoea, Heart rate decreased
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-11-20
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Allopurinol; ALTACE; Prednisone; Amiodarone; Furosemide
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2 hours after shot, he was short of breath - he said he need some oxygen - went to hospital - said pulse rate was too low 33-34. Was in hospital 3 days and pulse didn''t go up. 6/19/09 Death certificate received. Cause of Death: Urosepsis-secondasry COD Dehydration, dementia, renal failure.


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