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From the 11/12/2021 release of VAERS data:

Found 2,947 cases where Patient Died and Vaccination Date from '2010-01-01' to '2020-12-31'

Government Disclaimer on use of this data



Case Details

This is page 21 out of 295

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VAERS ID: 444038 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Nevada  
Vaccinated:2011-11-08
Onset:2011-11-11
   Days after vaccination:3
Submitted: 2011-11-30
   Days after onset:19
Entered: 2011-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB441BA / 2 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Cardiomyopathy, Death, Fatigue, General physical health deterioration, Hepatorenal failure, Laboratory test abnormal, Life support, Multi-organ failure, Nausea, Vomiting
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow), Chronic kidney disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2011-11-29
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO ILLNESS WAS REPORTED TO MD AT TIME OF IMMUNIZATION VISIT BUT FAMILY LATER REPORTED CONFLICTING AND VAGUE RECOLLECTIONS OF INTERMITTENT FLU LIKE SYMPTOMS AND FATIGUE OVER A 3 WK PERIOD PRIOR TO THE VACCINATION VISIT
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EXTENSIVE MULTIPLE SYSTEMIC WORKUP / MULTIPLE ORGAN FAILURE: CARDIOMYOPATHY, HEPATO-RENAL FAILURE.
CDC Split Type:

Write-up: ER VISIT C/O VOMITING NAUSEA ALSO REPORTING SIMILAR SYMPTOMS INTERMITTENTLY OVER PAST THREE DAYS-DISCHARGED HOME AFTER UNEVENTFUL ER WORK UP. RETURNED TO CLINIC FOR FOLLOW UP 11/14 AND REPORT OF INCREASING FATIGUE AND SIMILAR SYMPTOMS OVER PREVIOUS THREE WEEKS. ADMITTED TO HOSPITAL. RAPID DETERIORATION AND EMERGENCY XFER BY LIFE FLIGHT TO HIGHER LEVEL OF CARE$g MULTIPLE ORGAN FAILURE $g LIFE SUPPORT $g SUBSEQUENT DEMISE 11/29 AT OTHER HOSP.


VAERS ID: 444950 (history)  
Form: Version 1.0  
Age: 7.0  
Sex: Female  
Location: Vermont  
Vaccinated:2011-12-02
Onset:2011-12-03
   Days after vaccination:1
Submitted: 2011-12-08
   Days after onset:5
Entered: 2011-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH476AD / UNK LA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Autopsy, Culture negative, Death, Dyspnoea, Influenza like illness, Lethargy, Microscopy, Pain, Pyrexia, Resuscitation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-12-06
   Days after onset: 3
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: Gross Autopsy negative. Preliminary cultures negative Pending Microscopic examination
CDC Split Type:

Write-up: Went for well child check 12/2 no issues flu vaccination given. Next day developed flu like illness with fever 102.3, body aches lethargy, treated with Tylenol and Motrin, symptoms waxed and waned got significantly worse Tuesday 12/6/11 with dyspnea. Patient went unresponsive on way to pediatrician emergent resuscitation and died 12/6/11.


VAERS ID: 444965 (history)  
Form: Version 1.0  
Age: 97.0  
Sex: Female  
Location: Idaho  
Vaccinated:2011-11-30
Onset:2011-12-02
   Days after vaccination:2
Submitted: 2011-12-08
   Days after onset:6
Entered: 2011-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4147CA / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Anxiety, Breath sounds abnormal, Cardiac failure congestive, Condition aggravated, Dyspnoea, Oedema peripheral, Rales
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-12-04
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix, aldactone, Lanoxin, valproic acid, Senocot, Miralax
Current Illness: End-stage CHF- health declining
Preexisting Conditions: No known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Exacerbated CHF x 6 weeks with multiple changes in medications. ON continuous O2. 12/2 Extremely dyspnic with anxiety. Crackles right lung, diminished breath sounds. Increased peripheral edema.


VAERS ID: 445440 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Male  
Location: Vermont  
Vaccinated:2011-11-17
Onset:2011-12-08
   Days after vaccination:21
Submitted: 2011-12-14
   Days after onset:6
Entered: 2011-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB208AA / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Acute hepatic failure, Alanine aminotransferase increased, Analgesic drug level therapeutic, Aspartate aminotransferase increased, Computerised tomogram abnormal, Hepatic steatosis, Hepatitis C antibody positive, International normalised ratio increased, Terminal state, White blood cell count increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver-related coagulation and bleeding disturbances (narrow), Liver infections (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2011-12-16
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none that we are aware of
Preexisting Conditions: medical history unremarkable aside from psychiatric disorder
Allergies:
Diagnostic Lab Data: As of 12/14 death is imminent. Hep C IgM positive. On admission: WBC 10,200, INR 10.1, SGOT 7209, SGPT 11359, acetaminophen <10, CT shows diffuse fatty infiltrates.
CDC Split Type:

Write-up: Acute hepatic failure, question etiology, r/o relationship to recent Hepatitis A and Hepatits B vaccinations.


VAERS ID: 445447 (history)  
Form: Version 1.0  
Age: 45.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2011-12-05
Onset:2011-12-06
   Days after vaccination:1
Submitted: 2011-12-14
   Days after onset:8
Entered: 2011-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH476AD / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Malaise
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-12-09
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown at this time
CDC Split Type: MA1103

Write-up: PT became ill and reported to have gone to the ER.


VAERS ID: 445693 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Male  
Location: Maryland  
Vaccinated:2011-11-28
Onset:2011-12-02
   Days after vaccination:4
Submitted: 2011-12-16
   Days after onset:14
Entered: 2011-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39999AA / 4 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1068AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0513AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916921 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0950AA / 1 LL / SC

Administered by: Unknown       Purchased by: Public
Symptoms: Coagulopathy, Epistaxis, Haemoptysis, Peritoneal dialysis, Platelet count decreased, Renal failure acute, Respiratory failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen
Current Illness: no
Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay
Allergies:
Diagnostic Lab Data: unknown - evaluation at Hospital
CDC Split Type:

Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date.


VAERS ID: 445775 (history)  
Form: Version 1.0  
Age: 0.42  
Sex: Male  
Location: Texas  
Vaccinated:2011-12-08
Onset:2011-12-12
   Days after vaccination:4
Submitted: 2011-12-19
   Days after onset:7
Entered: 2011-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4083AA / 2 LL / -
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 917737 / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1347AM / 2 - / -

Administered by: Private       Purchased by: Private
Symptoms: Death, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-12-13
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccines in office on 12/08/2011. Patient''s mother stated he ran a low-grade fever of 100-101 that evening and was treated with Tylenol twice. No fever after that. Child passed away on 12/12/2011 of suspected SIDS.


VAERS ID: 446303 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Idaho  
Vaccinated:2011-10-26
Onset:2011-11-03
   Days after vaccination:8
Submitted: 2011-12-27
   Days after onset:54
Entered: 2011-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA651AA / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Diplopia, Facial paresis, Guillain-Barre syndrome, Hypoaesthesia, Lumbar puncture abnormal, Nerve conduction studies abnormal, Ophthalmoplegia, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Demyelination (narrow), Ocular motility disorders (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2012-04-18
   Days after onset: 167
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 60 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Peripheral neuropathy History of Bells palsy 2009
Allergies:
Diagnostic Lab Data: Nerve conduction test and lumbar puncture consistent with diagnosis. Pls note pt is now in acute care hospital setting.
CDC Split Type:

Write-up: Facial weakness, double vision, numbness tingling of extremities. Progressed to ophthalmoplegia, severe weakness, DX as Guillain Barre syndrome pt hospitalized.


VAERS ID: 446306 (history)  
Form: Version 1.0  
Age: 36.0  
Sex: Male  
Location: Texas  
Vaccinated:2011-08-01
Onset:2011-08-01
   Days after vaccination:0
Submitted: 2011-12-20
   Days after onset:141
Entered: 2011-12-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3694BA / UNK UN / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Abdominal pain upper, Activities of daily living impaired, Allergy test negative, Arthralgia, Asthenia, Asthma, Balance disorder, Biopsy, Biopsy lip, Blister, Blood test, Burning sensation, Cellulitis, Central nervous system lesion, Chills, Cold sweat, Colonoscopy, Coordination abnormal, Crying, Diarrhoea, Disability, Dizziness, Dysarthria, Dyspnoea, Ear discomfort, Echocardiogram, Electroencephalogram normal, Erythema, Extraocular muscle paresis, Eye pain, Eye pruritus, Eyelid oedema, Fatigue, Feeling abnormal, Formication, Gait disturbance, Gastrooesophageal reflux disease, Haematochezia, Head discomfort, Headache, Herpes zoster, Hyperaesthesia, Hypoaesthesia, Impaired work ability, Induration, Influenza like illness, Insomnia, Joint stiffness, Malaise, Memory impairment, Mental impairment, Motor dysfunction, Muscle spasms, Muscular weakness, Nausea, Nerve conduction studies, Nerve injury, Nuclear magnetic resonance imaging brain abnormal, Ocular hyperaemia, Oedema peripheral, Oesophageal pain, Oesophageal ulcer, Oesophagitis, Ophthalmological examination abnormal, Pain, Pain in extremity, Panic attack, Paraesthesia, Pruritus, Rash macular, Respiratory tract congestion, Sensation of heaviness, Sjogren's syndrome, Throat irritation, Throat tightness, Vision blurred, Vomiting, X-ray gastrointestinal tract abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal ulceration (narrow), Gastrointestinal haemorrhage (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Lacrimal disorders (narrow), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Meclizine 12.5mg; Cephalexin
Current Illness: 2 hrs after shot shortness of breath; Difficulty breathing
Preexisting Conditions: Temporal lobe epilepsy (released when I was 13)
Allergies:
Diagnostic Lab Data: Blood work equivocal - neurologist diagnosed possible Sjorgens syndrome waiting results - see notes; MRI - 1" lesion left temporal lobe
CDC Split Type:

Write-up: Aug. 1, 2011 Insect bite got infected went to clinic. Dr. gave Tdap and 2 antibiotics; Meclizine 12.5, cephalexin for infection and Staph, 2 hours after felt shortness of breath, dizzy, lightheaded, left shoulder arm tingly called clinic said don''t worry keep taking antibiotics. I have been to neurologist - 2 MRI found 1" lesion left temporal lobe, along neurosurgeon, cardiologist, rheumatologist, ENT, ophthalmologist, dermatologist, GI, dentist. No answers! Friday, July29 On Friday afternoon around 4:30p.m. I got in the shower and noticed a bite from an insect of some sort. On Saturday, July went to ask pharmacist to look at it. She said it looked infected and that I needed to go to the doctor. On Monday, August 1 I went to work and reported it to, Safety Director. She advised me to go to the clinic. I saw Dr. Dr. saw my foot and said that I had cellulitis and possible staph infection. She prescribed two antibiotics. One to treat staph and to fight infection. Meclizine 12.5 mg take one tablet by mouth twice daily as needed. The other antibiotic was cephalexin take one capsule by the mouth 4xs a day. That afternoon when I sat down to eat lunch I took the two pills prescribed. Shortly after, I was feeling lightheaded, dizzy, clammy, short of breath and chills. I went home still feeling bad, called clinic, told them my symptom sent back to my they told me everything was fine just continue taking antibiotics. Monday, August 8 Dr. saw for follow up and said that I could go back to work. Tuesday August 9&10 I went back to my regular work load which is installing a/c units. Wednesday, August 10 After lunch and got back to work site I felt lightheaded and dizzy. It was scary feeling was picked up by my boss and driven home. I was told to see my primary doctor which did. I saw Dr. at office. She said didn''t know what was going on with me and said to go to the emergency room if I got worse. Thursday, August 11 That evening I felt same symptoms felt lightheaded, dizzy, chills, and clammy. So I went to the emergency room thinking I was having a reaction to the vaccine; tetanus and/or antibiotics. Dr. was 18 attending physician. After having blood test, EKG and fluids given to me, Dr. concluded that there was nothing life threatening was told to go back to work on August 18. Wednesday August 17th Dr. office advised me to return back to work with lightheadedness. Friday, August 19 I returned back to work on light duty in the office. I still feel lightheaded and dizzy. I felt like needles were sticking in my head. My vision seemed to be blurred and severe headache. It''s the closest I''ve felt to deal. I felt that over the weekend. Monday, August 22 I worked all day 8:00-5:00 in the office but continued to feel lightheaded. Tuesday, August 23 I had two Dr. appointments one to cardiologist for echocardiogram and the other to an allergist. I gave blood and administered allergy tests along with asthma. Results were no known allergies at this time. He said it might be possible serum sickness. Safety Director finally gave me a nurse card. She said if anything else comes up medically to contact nurse. Wednesday, August 24 worked for five hours between going to draw blood again for allergy testing and going to have sonogram done on heart. Thursday, August 25 I was still working on light duty in the office I continue to have lightheadedness but I worked 8:00-5:00. Friday, August 26 I worked 8:00-5:00 felt lightheaded throughout the day. Saturday, August 27 noticed red blister on right cheek under eye. It was sensitive and blisters began to get bigger. Sunday, August 28 The blisters went from dime size to a fifty cent piece. I went to Urgent Care I saw Dr. She diagnosed it as Shingles. She prescribed Valacyclovir 1mg Three times a day. I felt achy, lightheaded, clammy, burning sensation, itching. She also prescribed Hydrocortisone cream for itching. Monday, August 29 I went to work 8:00-5:00 still feeling lightheaded and dizzy. I was working in office on light duty. Tuesday, August 30 I went to work 8:00-5:00 still feeling lightheaded and dizzy noticing blister drying up. Wednesday, August 31 I went to work 8:00-5:00 still feeling lightheaded, dizzy and achy. Thursday, September 1 I made appointment to go back to see Dr. at office. She is requesting more blood work. She is continuing to research allergic reactions from vaccine. I am still feeling lightheaded at times. It is sporadic. She has advised me to stay on light duty until all of the tests results are back. Friday, September 2 Blisters are going away but still feel lightheaded at times. Saturday, September 3 late that evening I noticed a knot on the right forearm sensitive, tender and swollen. I don''t know what it is. I am finished taking valacyclovir. I still feel lightheaded and dizzy, congested. Sunday, September 4 I woke up dizzy and lightheaded. Monday, September 5 I went to work. I left from desk around 12:00 to go eat as I walked into Cafe sat down felt on edge my left side of face felt numb and tingled. I have pressure in ears and head gets pain in it. Feels like I''m stomping and eyes are blurred vision I feel tired. Coordination is off and this has gone on since August 1 when I was diagnosed with cellulitis in right foot and was given a tetanus shot and prescribed two antibiotics. I''m not the same since this happened. Nothing is changing. It comes and goes. I''m always on the edge. I lose focus can''t concentrate and feels like memory plays tricks on me. Sometimes I walk around wondering what I''m doing I forget what I''m doing. My head feels heavy, I''m weak like I was struck by lightning, blurred vision, don''t go away. Left side of head around my temple and all on my head. My jaw sometimes feels like Lockjaw and it sometimes slurred speech. Pretty much my left side of face and head my left arm and my knees, my toes and fingers get tingly and numb. My coordination is off and so is my motor skills. I can''t think straight I''m sick of it. Even felt nauseous. I have had stomach pains. I feel spaced out---- nose sometimes gets numb and tingly my left eye has been red and I feel brain dead. Tuesday September 6 Just feel in a daze. Wednesday, September 7-October 10 night trying to go to sleep. It was difficult due to shortness of breath. But finally around 1:30a.m. fell asleep with gf. November 3 I got up to go to work. I felt a little off balance eyes blurred and tired. Blisters on face getting bigger. At work answering phones and feeling a little dizzy 11:45 am I went to lunch at 12:30 and I was starting to feel strange again I stopped and ate. I felt I was wired on drugs then when left it was like my throat was tight and was real dizzy and eyes were blurred and felt like I was going to stop breathing and die. My ears, eyes and motor ability was impaired. I am so tired of feeling like this. It''s scary. I have dealt with burning sensation in my nose, throat and had acid reflux and nausea, vomiting. I''ve dealt a lot of pain suffering 2:10 pain in my knees. Last night was feeling weak in legs, arms my head my eyes are weird in legs, arms my head. My eyes are weird. I went to my friend''s house and felt like I was going to fall over trying to walk in his door. I was slowed down. Friday, November 4 I woke up tired I''m at work answering phones no attack yet. That evening my energy was very bad. I was dizzy felt retarded like I had blurred vision and was very slow at moving weak knees and arm and legs I went to Dr. Saturday, November 5 Just laid around and was tired weak had blood in my stool twice. Monday, November 7 I went back to my neurologists EEG results were negative. He said didn''t find anything that looked to be a worry. As a matter of fact, he said it''s probably the Sjogren''s Syndrome causing the effects. Tuesday, November 8 8:10 am I went to eye doctor and had an eye exam done and of course nothing wrong that he could see my right eye 20-20 left eye was harder to read the line like the right and was like 20-35. My eyes get red mainly my left eye gets a bull red color day to day. Stayed home blurred vision due to dilation of eyes. November 9 Worked in office answering phones no weird feelings present while sitting it seems to come around eating and sun and heat. I got home around 5:30 pm and started feeling strange. Dizzy, short breath, itchy feet on the top of hands and feet. My joints hurt in my wrists and fingers my hands get splotchy red stripes across them and itch. November 10 Thursday morning woke up feeling dizzy, drunk feeling I have no idea what''s going on with my eyes and brain. I feel stupid retarded feeling. I ate some yogurt and couple pieces of chocolate and I''m feeling weird dizzy, short of breath, and my eyes feel weird and my brain something is attacking 9:30 am I feel strange, dizzy and brain. November 11th I went to work feel weird like something going on with my brain and vision. Balance and joint pain, red on hands pain comes and goes feel brain fog. Fatigue dizzy went to rheumatologist; blood test unequivocal for Sjogren''s syndrome was referred to dermatology, Dr. look at spot on face needs to be blistered before biopsy. Back at work no changes dizzy. Phone call from a radiologist for an appointment Jan 3. 9:15 am. Saturday, November 12 no change felt a little dizzy. Sunday, November 13 I went to mall walked around for an hour came back to truck and I was feeling tired, dizzy went home and watched tv and around 11:30 I went to lay down as I shut my eyes. I felt short of breath and had a panic of some sort. I had difficult time breathing. I was up to 3:30 am unable to go to sleep my body got numb and tingly. Monday, November 14 I went to draw blood went to lawyers office for consultation stayed with my parents around 10:30 I felt a little numb in my arms. I went to bed on October 10 I went to work light duty in office. I felt weird at 12:30 when I left to lunch feet and toes numb and face numb and tingly, dizzy and lightheaded, driving to go eat. Joints, muscles are weak like I have nerve damage, my eyes are blurred and my head and face are tingly. I cried a few min. and I''m not the same I feel fatigue tired like I don''t care anymore. Around 2:45 p.m. I called clinic and talked to someone and told her what all I''ve been through and she gave me a lot number and the name of the tetanus shot they gave me. Diphtheria Tetanus Exp. 2013 Lot#U3696BA the manufacturers name is SANOFI Pasteur Ingredients she said were Thimerosal, Aluminum Adjutant Residual Formaldehyde. Then she said someone would be getting back to me very soon. Never heard from anyone. I called office to see if they had made my other three appointments. She said she was faxing my referrals to them and I would be hearing from them soon. October 13 Went to another neurologist Dr. to get some answers. They did a serious blood test. Waiting for results. Went home feeling weak and dizzy. My arms felt heavy like lead like I could barely hold anything and it comes and goes. It''s a crawling feeling, numbness and fatigue. October 14- went to work answered phones. I did ok up till lunch. I went out to eat and felt weird again like my vision was blurred again, and I was off balance. Friday evening my gf came over. We went to dinner I drove and started having blurred vision in the dark on highway I was feeling weird around 8:00p.m. Saturday, October 15 I went to my parents ranch to get away the day to spend the night. It was a struggle to walk around to the feeders but I tried to work my muscles my vision and balance was off a bit it comes and goes. Sometimes I feel almost normal then here comes that feeling numbness, cramps in arms, joints, blurred fuzzy vision. Itchy on head sometimes feel like needles are stabbing me in stomach and head. Sunday October 16 I felt good most of the day up till the evening around 7:00 pm when I was going to eat I started feeling strange up to be time around 11:00 went to be woke up dizzy, and my fingers and toes and feet were numb and tingle last night, and was having needles stabbing me in my stomach and a pain in my head on left side like crawling weird pains. October 17th Monday morning woke up dizzy drove to work sitting to answer phones my head feels weird and face is a little numb on left side. Someone from my work come in to talk to me to say she and co-worker want to have a conference call meeting with me to go over my vacation time left and my opinions. October 18th 8:30 am went to my neurologist. Dr. to do a nerve study and get blood results and get diagnosed with Sjogren''s syndrome. I am being sent to a rheumatologist so I wait. 9:26 am I have a funny burning sensation in my throat esophagus. November 1 - Woke up in the middle of night stomach cramps then had bowel movement went back to bed. Got up again and had acid reflux threw up twice in toilet. I drove to work answering phones. Left work 1 hour early flu like symptoms diarrhea and throwing up. November 2 Stayed home sick getting a little better. That evening noticed red spot on my face started blistering again what was said to be shingles. My head was not feeling right and my vision is still fuzzy. My neighbor said my left eye was red and puffy. That problem. My walking was a little unsteady my knees felt like they were going to buckle very weak. November 15 woke up at 5:50 am a little dizzy. Pain in left eye sometimes itchy and weak. November 16 Pretty much the same comes and goes numbness and dizzy talked to co-worker. He is putting me on short term disability. November 17 Last day of work. November 18-23 weak, slow, fatigue and lots of joint pain I had GI doctor had colonoscopy and upper GI found ulcer in esophagus. (Esophagitis) prescribed NEXIUM. Still feel lightheaded, fatigue and dizzy, and joint pain. November 29 went to Dr.; she referred to ENT to take biopsy of mouth to determine if I have Sjogren''s Syndrome. November 29-December 6 dizzy, lightheaded, joint pain and fatigue. Friday, December 9 Extremely dizzy, very fatigue moved very slowly. Saturday, December 10 Very fatigue joint tenderness in knuckles, wrists, left shoulder I could hardly walk very tired and slowed down. Motor coordination very weak. Sunday, December 11 very tired and laid on couch most of the day no energy. Monday, December 12 Still very tired and laid around joint pain. Tuesday, December 13 Went to see ENT Dr. consult. Wednesday, December 14 Dr. did lip biopsy had to put 2-3 stitches on left side of mouth and took skin from right side too. I felt lightheaded, no energy tired joint pain throughout body. Friday December 16 2:00 pm driving to back; had difficulty breathing nose numb, shortness of breath lasted two hours almost had to pull over and call EMS left shoulder tingly, weak knees, ankles, knuckles, wrist, all joint areas very painful. December 17-21 Very fatigue, joint pain, knuckles pain in the center of my palm. December 22 Going back to ENT to get results of lip biopsy; extreme fatigue, pain in joints especially knuckles and hands cramping wrists. Jan. 3 3rd MRI. Jan. 4 GI follow up visit for esophagitis. Jan. 5 Dr. rheumatologist follow up. Feb. 6 follow up with neurologist Dr. from 3rd MRI.


VAERS ID: 446332 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Male  
Location: Georgia  
Vaccinated:2011-11-18
Onset:2011-11-20
   Days after vaccination:2
Submitted: 2011-12-22
   Days after onset:32
Entered: 2011-12-28
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH505AA / 1 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Aphagia, Death, Headache, Malaise
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-11-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient had a medical history of increased blood pressure and "Dbj". It was unknown if the patient had any illnesses at the time of vaccination, or had any vaccinations within 4 weeks of the influenza vaccine. The patient''s concomitant medications were unknown. It was reported that the patient had no previous influenza vaccines.
Allergies:
Diagnostic Lab Data: Not reported
CDC Split Type: 201112429

Write-up: Initial report was received on 19 December 2011 from a consumer who is also the patient''s parent and additional information was received from a health care professional. A 43-year-old male patient received an injection (route and site not reported) of INFLUENZA VACCINE, Sanofi Pasteur Inc. lot not reported, on 17 November 2011 (also reported as 18 November 2011). The patient had a medical history of increased blood pressure and "Dbj". It was unknown if the patient had any illnesses at the time of vaccination, or had any vaccinations within 4 weeks of the influenza vaccine. The patient''s concomitant medications were unknown. It was reported that the patient had no previous influenza vaccines. The parent stated that the patient was seen by her on 18 November 2011 and he had been sick after receiving the influenza vaccine and was having a severe headache and could not eat. The patient had called 911 on Sunday and was taken to a hospital. The patient died on 21 November 2011. The outcome was reported as fatal. Documents held by sender: None.


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