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From the 1/7/2022 release of VAERS data:

Found 3,129 cases where Patient Died and Vaccination Date from '2007-08-01' to '2020-11-30'

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Case Details

This is page 29 out of 313

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VAERS ID: 360138 (history)  
Form: Version 1.0  
Age: 0.27  
Sex: Male  
Location: Kentucky  
Vaccinated:2009-09-02
Onset:2009-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / UNK RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / UNK LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / UNK LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Herpes simplex serology negative, Intensive care, Metabolic function test, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-10-05
   Days after onset: 32
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 32 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC Split Type:

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


VAERS ID: 360397 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Male  
Location: New York  
Vaccinated:2009-10-02
Onset:2009-10-02
   Days after vaccination:0
Submitted: 2009-10-02
   Days after onset:0
Entered: 2009-10-12
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 98441P1A / UNK RA / UN

Administered by: Private       Purchased by: Other
Symptoms: Cardiac arrest, Circulatory collapse, Death, Malaise
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), 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), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-10-02
   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: None
Preexisting Conditions: Kidney stones.
Allergies:
Diagnostic Lab Data: None performed
CDC Split Type:

Write-up: Patient to PMD for physical. Was feeling well and received flu vaccine. Upon arriving home minutes later told wife "I don''t feel well" and collapsed. Brought to ED in full cardiac arrest. Unable to resuscitate. 10/19/09 ER records received service date 10/2/09. Assessment: Cardiac Arrest. Patient arrived unresponsive, intubated with CPR in progress. Asystole on monitor with no spontaneous respirations. External trauma to eyes. ICD-9 code 427.5 cardiac arrest. 12/16/09 Death Certificate received. DOD 10/02/09. Cause of Death - Hypertensive and arteriosclerotic heart disease.


VAERS ID: 360527 (history)  
Form: Version 1.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2009-09-22
Onset:0000-00-00
Submitted: 2009-10-09
Entered: 2009-10-12
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR C3202AA / 2 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3249AA / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-10-03
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:
CDC Split Type:

Write-up: None stated. 11/30/09 Death Certificate Received. DOD 10/03/2009. Final Cause of Death: Acute Methadone Toxicity. Additional Information - Underlying conditions: Constrictive Atherosclerotic Artery Disease.


VAERS ID: 360706 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Female  
Location: Virginia  
Vaccinated:2009-10-02
Onset:2009-10-03
   Days after vaccination:1
Submitted: 2009-10-13
   Days after onset:10
Entered: 2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 98431P1 / UNK LA / UN

Administered by: Other       Purchased by: Private
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-10-03
   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: Metformin; Aricept; Coreg; HCTZ; Lexapro; Lisinopril; Synthroid; Namend; Insulin; Simvastatin
Current Illness: Diabetes; HTN; Dementia; hypothyroidism
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. expired on 10/3/09. Attending MD did not believe immunization was cause of death but reported because of dose temporal proximity. (Pt. expired approx. 24 hrs after receiving the flu vaccine). 10/16/09 Death Certificate: Cardiorespiratory arrest, Diabetes mellitus type 2, Hypertension.


VAERS ID: 360751 (history)  
Form: Version 1.0  
Age: 1.04  
Sex: Male  
Location: Michigan  
Vaccinated:2009-10-01
Onset:2009-10-04
   Days after vaccination:3
Submitted: 2009-10-08
   Days after onset:4
Entered: 2009-10-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3178DA / 1 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB334BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF673AA / 4 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0554Y / 1 LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0731Y / 1 RA / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Seizure disorder; DANDY WALKER syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was seen on 10/1/09. Death reported on 10/4/09. Pt has seizure disorder along with encephalocele. / DANDY WALKER Syndrome. Had received vaccines on 10/1/09.


VAERS ID: 360985 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Male  
Location: Wisconsin  
Vaccinated:2009-10-01
Onset:2009-10-05
   Days after vaccination:4
Submitted: 2009-10-08
   Days after onset:3
Entered: 2009-10-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Bradycardia, Death, Diarrhoea, Pyrexia, Resuscitation, Thirst, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-10-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: DOWN Syndrome; VSD; CHF
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient with hx of DOWN Syndrome, VSD, CHF developed loose stools and low grade fever within 12 hrs of receiving vaccines. Mom noted increase fluid demand and gave child extra water. Noted wheezing 10/4/09. Bradycardia alarm @ 0307 on 10/5/09. CPR no response.


VAERS ID: 361101 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Michigan  
Vaccinated:2009-10-15
Onset:2009-10-15
   Days after vaccination:0
Submitted: 2009-10-16
   Days after onset:1
Entered: 2009-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3211AA / 4 LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Autopsy, Death, Post procedural haemorrhage, Tracheostomy malfunction
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-10-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Received Tylenol during clinic visit to prevent fever
Current Illness: mild URI
Preexisting Conditions: ex 27 week prematurity, bronchopulmonary dysplasia, asthma, subglottic stenosis, tracheostomy-dependent, GERD, congenital hip dysplasia with absence of left femoral head, Grade 1 intraventricular hemorrhage. Bronchoscopy with laser treatment of subglottic granulation tissue 10/13/2009
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: Patient pulled out trach (witnessed by family members), unable to replace trach, trach site began gushing blood, patient coded. Temperature in ER was 36.9 at the time of arrival at 8:22 p.m. Pronounced dead at 8:47 p.m.


VAERS ID: 361215 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: New York  
Vaccinated:2009-10-01
Onset:2009-10-02
   Days after vaccination:1
Submitted: 2009-10-16
   Days after onset:14
Entered: 2009-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA256AA / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Body temperature increased, Chest X-ray normal, Death, Respiratory rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-10-05
   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: Coumadin, Fosamax, Vit. D, Zocor, Amiodarone HCL, Finasteride F/C, Prednisone, Multivitamin, Vit. C, Xalatan eye drops, Calcium Antacid, Demeclomycin, Brimonidine Tartrate eye drops
Current Illness: no
Preexisting Conditions: other disorders of neurohypophysis 253.6, history of TIA/CVA, Polymyalgia Rheumatica
Allergies:
Diagnostic Lab Data: Chest x-ray negative for active disease. 10/19/09 Nursing Home medical records received service dates 10/1/09 to 10/5/09. LABS and DIAGNOSTICS: Chest X-ray - cardiomegaly.
CDC Split Type:

Write-up: Temp 103.2 at 0240 AM, rapid respirations began approx 12 hours later. 10/19/09 Death Certificate DOD 10/5/09 - Complications / effects of Influenza Vaccine. 10/19/09 Nursing Home medical records received service dates 10/1/09 to 10/5/09. Patient develops elevated temperature. Tylenol given, blankets removed and cool cloths applied. Oxygen via face mask. Respiration rate increased, mouth breathing. Appetite poor, not eating. Lethargic. Coughing. Unable to swallow. Unresponsive to voice or painful stimuli. Unable to obtain BP or radial pulse. Labored respirations. Stopped breathing. Death. Concurrent Illness: Toe has red flat area.


VAERS ID: 361282 (history)  
Form: Version 1.0  
Age: 89.0  
Sex: Female  
Location: California  
Vaccinated:2009-10-09
Onset:2009-10-12
   Days after vaccination:3
Submitted: 2009-10-16
   Days after onset:4
Entered: 2009-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3198AA / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-10-12
   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: Reglan, Calcium
Current Illness: None
Preexisting Conditions: NKDA, Medical conditions are Benign Hypertension, Osteoporosis, Sleep Disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unknown. 11/6/09 Autopsy report received. DOD 10/12/09. Anatomic Diagnosis: 1. Coronary artery disease. 2. Cardiac rupture with cardiac tamponade. 3. Pleural effusion. 4. Status post cholecystectomy and appendectomy. 11/12/09 Coroner - Final Cause of Death: Severe coronary atherosclerosis.


VAERS ID: 361353 (history)  
Form: Version 1.0  
Age: 9.0  
Sex: Female  
Location: California  
Vaccinated:2009-10-08
Onset:2009-10-14
   Days after vaccination:6
Submitted: 2009-10-16
   Days after onset:2
Entered: 2009-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3203AA / 3 LA / IM
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)) / MEDIMMUNE VACCINES, INC. 500751P / 1 NS / IN

Administered by: Private       Purchased by: Unknown
Symptoms: Blood alkaline phosphatase normal, Blood glucose normal, Death, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Immunohistochemistry, Neisseria test positive, Pupil fixed, Red blood cell sedimentation rate increased
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2009-10-14
   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: Limping
Preexisting Conditions: H/O Leukemia 2002; Down''s Syndrome. 1022/09 PCP /Nursing medical records received, service dates 11/11/03 to 10/14/09. Down Syndrome. Cough, fever. Frequent colds. Discharge from eyes. Vomiting and diarrhea. Lymphadenopathy. Foot pain. CBC abnormal.
Allergies:
Diagnostic Lab Data: CBC: 2.5, 7.5, 21.3, 207; Sed rate 125. 10/20/09 ER records received service date 10/14/09. LABS and Diagnostics: EEG - Asystole. CHEM - Glucose 107 mg/dL (H) Calcium 3.5 mg/dL (L) Albumin 3.4 g/dL (L) Alk Phos 170 U/L (L). CBC - WBC 2.5 Thou/uL (L) RBC 2.57 Mill/uL (L) HGB 7.5 g/dL (L) HCT 27.3% (L) RDW 16.4% (H) Neut ABS 565 cells/uL (L) Mono ABS 33 cells/uL (L) Eosin 3 cells/uL (L)
CDC Split Type:

Write-up: None Stated. On 10/19/09, the PCP stated that coroner called him and told him that he found consolidation of the lungs on autopsy. Autopsy report is not complete yet. 10/20/09 ER records received service date 10/14/09. Assessment: Cardiac arrest. CPR initiated. Pupils fixed and dilated. Apnea, pale. Rigor, lividity. 1022/09 PCP /Nursing medical records received, service dates 11/11/03 to 10/14/09. Assessment: Death. Office staff unable to contact patient''s family, eventually visited patient''s home. learnd that patient was found dead at home and taken to ER. 11/3/09 Additional ER records received for service date 10/14/09. Found supine on floor at home apneic and pulseless. Cardiac arrest. CPR initiated. 12/8/09 Autopsy received. Pronounced dead on 10/13/2009 Final cause of death: Pneumococcal Pneumonia. Pandemic Influenza A. Additional Information Abstracted: Other contributing conditions - Leukopenia, history of leukemia, Down syndrome. Drug Screen Heart Blood: Dextromethorphan <0.10 ug/ml, Promethazine 0.11 ug/ml. /ksk 12/28/09 Pathology report received. Receipt date 10/23/2009. Sign out date 12/21/2009. Diagnosis: Lung - Diffuse alveolar damage and bronchopneumonia. Immunohistochemical and molecular evidence of novel influenza A H1N1. Immunohistochemical and molecular evidence of Streptococcus pneumoniae. Immunohistochemical evidence of Neisseria meningitidis without molecular confirmation. No immunohistochemical evidence of Group A Streptococcus or Haemophilus influenzae. All follow-up attempts have been completed per company SOPs. No further information available.


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