From the 1/7/2021 release of VAERS data:

Found 1,919 cases where Vaccine targets Influenza (FLU(H1N1) or FLU3 or FLU4 or FLUA3 or FLUC3 or FLUC4 or FLUN(H1N1) or FLUN3 or FLUN4 or FLUR3 or FLUR4 or FLUX or FLUX(H1N1) or H5N1 or FLUA4) and Patient Died

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VAERS ID: 155888 (history)   Form: Version 1.0   Age:    Sex: Female   Location: Florida   Vaccinated: 1999-11-29 Onset: 1999-12-03    Days after vaccination: 4 Submitted: 2000-06-29    Days after onset: 208 Entered: 2000-07-03    Days after submission: 4 Vaccin­ation / Manu­facturer Lot / Dose Site / Route FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM Administered by: Military       Purchased by: Military Symptoms: Dyspnoea, Fatigue, Hypoxia, Nausea, Pneumonitis, Pyrexia, Rheumatoid factor SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad) Life Threatening? No Birth Defect? No Died? Yes    Date died: 2000-01-06    Days after onset: 34 Permanent Disability? No Recovered? No Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? Yes, 31 days    Extended hospital stay? No Previous Vaccinations: Other Medications: Methotrexate tablet, amantadine, calcium Current Illness: UNK Preexisting Conditions: arthritis, parkinsonism, blepharitis, drug hypersensitivity Allergies: Diagnostic Lab Data: open lung biopsy-acute interstitial pneumonitis. A bronchoscopy examination on 12/10/99 was unremarkabl; however, microscopic analysis of pooled bronchoalveolar levage revealed acute and chronic inflammation with rare atypical squamous and bronchial epithelial cells. Bronchial lavage cultures were negative. A chest x-ray on 12/13/99, revealed progressive RUL infiltrate with no improvement in severe bilateral lparenchymal disease compared to 12/12/99. A chest x-ray on 12/15/99 revealed significant improvement since 12/14. Lab test results in December 1999 included: rheumatoid factor, positive; ANA negaitve; and ESR 106. Based on these lab results and the fact that the pt remained afebrile, the neurologist suggested htat an autoimmune process should be considered. ON 12/10/99, C-ANCA and P-ANCA were both negtive. The pt''s WBC count rose steadily from 14,400 cells/mm^3 on 12/10/99 to 40,700 cells/mm^3 on 1/6/00. . Findings during a lung biopsy on 12/21/99 were a severely diffuse process with ver friable weak lung prenchyma incapable of holding either stapling devices and/or sutures. Cultures of lung tissue were negative for bacteria, virus and fungi. Blood cultures on 12/20/99 were positive for coagulase-negative Staphylococci and sputum cultures were positive for presumptive Candida albicans. A sputum culture on 1/4/00 was positive for P. seruginosa. A PPD performed during the hospital stay was negative. On 12/23/99, a chest x-ray revealed a small apical pneumothorax and development of what appeared tobe pneumopericardium and neumomediastinum since 12/22/99, with persistent bilateral pulmonary densities consistent with severe pulmonary edema. Hematology results on 12/7/99,included WBC and absolute neutrophil count which rose from 7.3 x 10^3 and 6.12 x 10^3 respectively, to 12.4 x 10^3 and 10.68 x 10^3 on 12/9/99. Seurm osmolarity was 253 and potassium was 2.4 on 12/7/99. Lab test results on 12/8/99 were creatinine 0.4; sodium 125; and chloride 94. Blood, pleural fluid, and urine cultures were negative. A chet x-ray on 12/7/99, revealed a dense upper lobe consolidation (lung infiltration NOS) with focal areas at the right base and mid-lung. A chest x-ray on 12/9/99 revealed worsening bialteral air-space consistent with pneumonia, pulmonary hemorrhage, or atypical pulmonary edema. A CT scan of the chest showed a predominatly alveolar process with marked areas of consolitation involving the lungs bilaterally; a moderately large right-sided pleural effusion; right lobe volume loss; and atherosclerotic aortic disease. An abdominal x-ray on 12/8/99 was suggestive of ileus. CDC Split Type: HQ7946728JUN2000 Write-up: Pt received flu vax on 11/29/99. The pt was receiving weekly methotrexate to treat rheumatoid arthritis at the time of immunization. She became ill on 12/3/99. On 12/7/99, she was seen by her physician and hospitalized in the ICU. She required mechanical ventilator on 12/12/99. The pt died on 1/6/00. The treating physicians reportedly attributed this event to the methotrexate therapy. The husband attributed this event to an interaction between the flu vax and methotrexate. On Follow-up pt had a history of Parkinsonism. Medical records were recieved on 7/12/00. The pt had increasing shortness of breath and fatigue for months prior to hospitalization. On 12/7/99, she was hospitalized because of fatigue, shortness of breath, nausea, and possible low-grade fever. Medical history included allergies to metoclopramide, ibuprofen, and salsalate. During hospitalization, her rheumatoid factor was positive; ANA titer was negative, ESR was 106mm/hr. Chest x-ray revealed "severe bilateral parenchymal disease since December 12, 1999." Follow up info was received from a medical center on 8/17/00, 9/28, and 10/25/00.The pt is a non-smoker and abstains from alcohohl. She has a past hisotry of bilateral silicone breast implant with subsequent removal, partial vaginal hysterectomy, tubal ligation. She also had problems with occasional choking and gasping while eating and drinking, though no recent episodes of aspiration were reported. the pt''s medical history includes a recent treatment with Mirapex and requip, which were discontinued due to "intolerance." Therapy with Methotrexate 15mg weekly for rheumatoid arthritis began in 1997 and ceased after 12/5/99. The pt received her 1999-2000 formula influenza virus vaccine on 11/29/99, approximately 14 hrs afte her methotrexate dose. A chest x-ray revealed bialteral infiltrates with the greatest concentration int he left perihilar and righ tupper lobe region. The differential diagnosis at this time included congestive heart failure, aspiration, connective tissue disease, drug reaction, atypical community acquired pneumonia, and other atypical infections. Immunosuppresive therapy, including methotrexate, was withdrawn. A bronchoscopy examination on 12/10/99 was unremarkable; however, microscopic analysis of pooled bronchoalveolar levage revealed acute and chronic inflammation with rare atypical squamous and bronchial epithelial cells. Bronchial lavage cultures were negative. The pt was inturbated and ventilated on 12/12/99. A chest x-ray on 12/13/99, revealed progressive RUL infiltrate with no improvement in severe bilateral lparenchymal disease compared to 12/12/99. The pt was also treated with piperacillin/tazobactam and imipenem/cilastatin. Additional therapy included furosemide, propofol and lorazempam. Physical examination on 12/13/99 revealed lungs iwth bialteral rhonchi and rales. A chest x-ray on 12/15/99 revealed significant improvement since 12/14. Lab test results in December 1999 included: rheumatoid factor, positive; ANA negaitve; and ESR 106. Based on these lab results and the fact that the pt remained afebrile, the neurologist suggested htat an autoimmune process should be considered. ON 12/10/99, C-ANCA and P-ANCA were both negtive. The pt''s WBC count rose steadily from 14,400 cells/mm^3 on 12/10/99 to 40,700 cells/mm^3 on 1/6/00. Amantadine was discontinued due to the pt''s fatigue. Findings during a lung biopsy on 12/21/99 were a severely diffuse process with ver friable weak lung prenchyma incapable of holding either stapling devices and/or sutures. The lung was extremely abnormal and did not appear to be ventilating or aerating well. Microscopic analysis revealed rapidly progressive diffuse alveolar damage considdtent with acute interstitial pneumonitis of unknown etiology. The abnormalities were temporally uniform and reflected an episode of massive acute lung injury occurring at a single point in time. The pt continued to have a persisitent broncho-alveolar fistula following thoracic surgery. Cultures of lung tissue were negative for bacteria, virus and fungi. Blood cultures on 12/20/99 were positive for coagulase-negative Staphylococci and sputum cultures were positive for presumptive Candida albicans. A sputum culture on 1/4/00 was positive for P. seruginosa. A PPD performed during the hospital stay was negative. On 12/23/99, a chest x-ray revealed a small apical pneumothorax and development of what appeared tobe pneumopericardium and neumomediastinum since 12/22/99, with persistent bilateral pulmonary densities consistent with severe pulmonary edema. The impression was that ARDS was a consideration. Corticosteroid therapy with subsequently initiated. The consumer reported that the pt had lost "50% of her then reduced lung capacity" and she required an increase in her oxygen from "60% to 100% and requiring paralyzing drugs." A chest x-ray on 1/6/00 revealed a reduced right apical pneumothorax with dense infiltrates bilaterally. There appeared to be increase in air within the right basilar pleural space compared to prior film. Subcutaneous emphysema is increased in the right axillary region. She died on 1/6/00, from respiratory failure secondary to acute interstitial penumonitis. The consumer reported that the event was a result of a compromised immune system, which the consumer felt was exacerbated by the influenza virus vaccine. The pulmonologist confirmed the pneumonitis, but due to its uncertain etiology, could not confirm that the pt had pneumonia. Further medical records recieved on 9/28/00, provided additional medical history of bone mass decreased (osteopenia), gastro-oesophageal reflux disease; los of balance resulting in falls, and headaches NOS. Medications included /Relafen, Sinemet. On 12/7/99, the pt''s flu-like illness included scratchy, then sore throat, cough and chills. Hematology results on 12/7/99,included WBC and absolute neutrophil count which rose from 7.3 x 10^3 and 6.12 x 10^3 respectively, to 12.4 x 10^3 and 10.68 x 10^3 on 12/9/99. Seurm osmolarity was 253 and potassium was 2.4 on 12/7/99. Lab test results on 12/8/99 were creatinine 0.4; sodium 125; and chloride 94. Blood, pleural fluid, and urine cultures were negative. A chet x-ray on 12/7/99, revealed a dense upper lobe consolidation (lung infiltration NOS) with focal areas at the right base and mid-lung. A chest x-ray on 12/9/99 revealed worsening bialteral air-space consistent with pneumonia, pulmonary hemorrhage, or atypical pulmonary edema. A CT scan of the chest showed a predominatly alveolar process with marked areas of consolitation involving the lungs bilaterally; a moderately large right-sided pleural effusion; right lobe volume loss; and atherosclerotic aortic disease. An abdominal x-ray on 12/8/99 was suggestive of ileus. Her diagnosis at this time was RUL infiltrate and pleural effision, thought to be secondary to aspiration. She also had ileus and hyponatremia secondary to SIADH, both considered secondary to the pulmonary proces. The pt also had increased lower extremity weakness. (Reference methotrexate case number HQ7226113JUN2000).

VAERS ID: 160801 (history)   Form: Version 1.0   Age: 87.0   Sex: Male   Location: Illinois   Vaccinated: 2000-10-10 Onset: 2000-10-15    Days after vaccination: 5 Submitted: 2000-10-20    Days after onset: 5 Entered: 2000-10-23    Days after submission: 3 Vaccin­ation / Manu­facturer Lot / Dose Site / Route FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM Administered by: Unknown       Purchased by: Unknown Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, ? days    Extended hospital stay? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: chest x-ray - interstitial infiltrates CDC Split Type: U2000007670 Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.

VAERS ID: 160872 (history)   Form: Version 1.0   Age: 55.0   Sex: Female   Location: New Mexico   Vaccinated: 2000-10-09 Onset: 2000-10-09    Days after vaccination: 0 Submitted: 2000-10-18    Days after onset: 9 Entered: 2000-10-25    Days after submission: 7 Vaccin­ation / Manu­facturer Lot / Dose Site / Route FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / UNK - / IM Administered by: Private       Purchased by: Other Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring SMQs:, Anaphylactic reaction (broad), Disorders of sinus node function (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow) Life Threatening? No Birth Defect? No Died? Yes    Date died: 2000-10-09    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: unspecified inhaler Current Illness: Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma Allergies: Diagnostic Lab Data: CDC Split Type: MPI2000047920 Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothyroidism, and allergies to penicillin, rvp dye, shellfish, and Tegretol.

VAERS ID: 161041 (history)   Form: Version 1.0   Age: 82.0   Sex: Female   Location: Ohio   Vaccinated: 2000-10-19 Onset: 2000-10-20    Days after vaccination: 1 Submitted: 2000-10-23    Days after onset: 3 Entered: 2000-10-27    Days after submission: 4 Vaccin­ation / Manu­facturer Lot / Dose Site / Route FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 2 LA / IM Administered by: Private       Purchased by: Other Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes    Date died: 2000-10-20    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: Preexisting Conditions: CAD, DM, HTN, MI, CVA Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00.

VAERS ID: 161416 (history)   Form: Version 1.0   Age: 79.0   Sex: Male   Location: Illinois   Vaccinated: 2000-10-10 Onset: 2000-10-15    Days after vaccination: 5 Submitted: 2000-11-02    Days after onset: 18 Entered: 2000-11-07    Days after submission: 5 Vaccin­ation / Manu­facturer Lot / Dose Site / Route FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM Administered by: Other       Purchased by: Unknown Symptoms: Apnoea, Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad) Life Threatening? No Birth Defect? No Died? Yes    Date died: 2000-10-16    Days after onset: 1 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? Yes, 5 days    Extended hospital stay? No Previous Vaccinations: Other Medications: Current Illness: CHF; pneumonia Preexisting Conditions: Allergies: Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted. CDC Split Type: U2000007672 Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00 not on 10/15/00 as previously reported. Additional pt and responsible physician information were also provided.

VAERS ID: 161790 (history)   Form: Version 1.0   Age: 94.0   Sex: Male   Location: Oklahoma   Vaccinated: 2000-11-03 Onset: 2000-11-08    Days after vaccination: 5 Submitted: 2000-11-10    Days after onset: 2 Entered: 2000-11-13    Days after submission: 3 Vaccin­ation / Manu­facturer Lot / Dose Site / Route FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008173 / 1 RA / IM Administered by: Other       Purchased by: Public Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Akathisia (broad), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow) Life Threatening? Yes Birth Defect? No Died? Yes    Date died: 2001-02-07    Days after onset: 91 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? Yes, ? days    Extended hospital stay? No Previous Vaccinations: Other Medications: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone Current Illness: NONE Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 states the pt passed away on 2/7/01. Cause of Death - pneumonia.

VAERS ID: 162101 (history)   Form: Version 1.0   Age: 83.0   Sex: Male   Location: Iowa   Vaccinated: 1999-10-14 Onset: 1999-10-29    Days after vaccination: 15 Submitted: 2000-11-13    Days after onset: 381 Entered: 2000-11-17    Days after submission: 4 Vaccin­ation / Manu­facturer Lot / Dose Site / Route FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998217 / 1 - / IM Administered by: Unknown       Purchased by: Unknown Symptoms: Cough, Haemoptysis SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Infective pneumonia (broad) Life Threatening? Yes Birth Defect? No Died? Yes    Date died: 1999-12-23    Days after onset: 55 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? Yes, 11 days    Extended hospital stay? No Previous Vaccinations: Cough~Influenza (Seasonal) (no brand name)~~82.00~In Patient Other Medications: Accupred, Lasix, K-Dur, Prilosec Current Illness: Preexisting Conditions: Hypertension, CHF, hypercholesterolemia, Allergies: Diagnostic Lab Data: X-rays, lung scrub, tests (nos). CDC Split Type: Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.

VAERS ID: 163506 (history)   Form: Version 1.0   Age: 71.0   Sex: Male   Location: Georgia   Vaccinated: 2000-11-21 Onset: 2000-11-21    Days after vaccination: 0 Submitted: 2000-11-22    Days after onset: 1 Entered: 2000-12-11    Days after submission: 19 Vaccin­ation / Manu­facturer Lot / Dose Site / Route FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR 40422CA / 4 RA / IM Administered by: Public       Purchased by: Public Symptoms: Unevaluable event SMQs: Life Threatening? No Birth Defect? No Died? Yes    Date died: 2000-11-21    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: UNK Current Illness: NONE Preexisting Conditions: CAD Allergies: Diagnostic Lab Data: CDC Split Type: GA00123 Write-up: The pt received the flu shot on 11/21/00 without complications. The pt was found ill at home by his son and subsequently died at 5:00pm that same day.

VAERS ID: 163596 (history)   Form: Version 1.0   Age: 4.0   Sex: Male   Location: Alabama   Vaccinated: 2000-12-04 Onset: 2000-12-05    Days after vaccination: 1 Submitted: 2000-12-05    Days after onset: 0 Entered: 2000-12-12    Days after submission: 7 Vaccin­ation / Manu­facturer Lot / Dose Site / Route FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0415AA / 1 LL / IM Administered by: Private       Purchased by: Public Symptoms: Cardiac arrest, Respiratory arrest SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow) Life Threatening? No Birth Defect? No Died? Yes    Date died: 2000-12-05    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: Zyrtec, Cortef, DDAVP, Synthroid, Dimetapp, Ventolin Current Illness: ROM, URI Preexisting Conditions: Optic Glioma, Panhypopituitarism, GERD, Seizures Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: The pt arrived at the medical center in full arrest. Grandmother had found him struggling for breath in bed. Death certificate received states cause of death: respiratory arrest due to cardiac arrest due to respiratory distress. Other significant conditions noted was a brain tumor.

VAERS ID: 163673 (history)   Form: Version 1.0   Age: 80.0   Sex: Male   Location: Connecticut   Vaccinated: 2000-11-30 Onset: 2000-12-01    Days after vaccination: 1 Submitted: 2000-12-12    Days after onset: 11 Entered: 2000-12-13    Days after submission: 1 Vaccin­ation / Manu­facturer Lot / Dose Site / Route FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E59090GA / UNK LA / IM Administered by: Public       Purchased by: Public Symptoms: Circulatory collapse, Feeling abnormal, Vomiting SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow) Life Threatening? No Birth Defect? No Died? Yes    Date died: 2000-12-01    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: Preexisting Conditions: Allergies: Diagnostic Lab Data: NONE CDC Split Type: CT200006 Write-up: Pt volunteer fireman, called out on evening of 12/1/00, was photographer. Wasn''t feeling well. Vomited at the scene. Refused treatment by EMT''s. Returned home, collapsed and EMT''s were unable to resuscitate.

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