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From the 9/17/2021 release of VAERS data:

Found 3,093 cases where Patient Died and Vaccination Date from '2007-08-01' to '2020-11-30'



Case Details

This is page 3 out of 310

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VAERS ID: 293120 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Male  
Location: Texas  
Vaccinated:2007-10-15
Onset:2007-10-15
   Days after vaccination:0
Submitted: 2007-10-15
   Days after onset:0
Entered: 2007-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA300BA / UNK LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Cardiac arrest, Death, Resuscitation, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-15
   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: unknown
Current Illness: unknown; code team contacted his supervisor who reports that he was well the morning of 10/15/2007.
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received influenza vaccine at 1105 AM 10/15/2007 and was found asystolic and unresponsive in the parking lot at 1138 AM. Resuscitative efforts were unsuccessful.


VAERS ID: 293421 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Florida  
Vaccinated:2007-10-01
Onset:2007-10-04
   Days after vaccination:3
Submitted: 2007-10-13
   Days after onset:9
Entered: 2007-10-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133BA / 2 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0073U / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B5007H / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0240U / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-04
   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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death 11/27/07 Reviewed vax record which confirms dose & lot #s as reported. 4/15/08 Autopsy report states COD as anoxic/hypoxic encephalopathy & bronchopneumonia due to infantile reflux & aspiration while sleeping.


VAERS ID: 293594 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2007-10-18
Onset:2007-10-18
   Days after vaccination:0
Submitted: 2007-10-18
   Days after onset:0
Entered: 2007-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78995 / 7+ RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-18
   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: unknown
Current Illness:
Preexisting Conditions: PMH: COPD on home O2. ASCVD, s/p CABG. Recent hx of hemoptysis & URI
Allergies:
Diagnostic Lab Data: CXR right pneumothorax.
CDC Split Type:

Write-up: Client presented to drive through flu exercise for influenza vaccination. Gave history of having had flu shots in past without incident. No contraindications to vaccinations identified. Client was vaccinated and returned home. At some time after returning home client went to Hospital emergency room where he coded and expired. 10/23/07 Reviewed hospital medical records which reveal patient experienced weakness & decreased respirations upon arriving home s/p flu shot. Collapsed in seat of pickup truck. EMS intubated, started CPR & transported to hospital. CXR revealed right pneumothorax & chest tube placed. 1/8/08 Reviewed autopsy report which states COD as COPD with atherosclerotic cardiovascular disease & CHF as contributing factors.


VAERS ID: 294105 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Male  
Location: Iowa  
Vaccinated:2007-10-05
Onset:0000-00-00
Submitted: 2007-10-16
Entered: 2007-10-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1347U / 1 LA / UN

Administered by: Other       Purchased by: Other
Symptoms: Body temperature increased, Breath sounds abnormal, Cyanosis, Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-09
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clotrimazole, Diltiazem HCL, Fosamax tablet, Spriva Handhaler, therapeutic tablet, Warfarin sodium, Docusate Sodium, GNP calcium, Lorazepam, Genebs Apap, Prednisone
Current Illness:
Preexisting Conditions: Demerol PMH: pulmonary fibrosis. Recently hospitalized for pneumocystis pneumonia, pulmonary embolism & generalized frailty.
Allergies:
Diagnostic Lab Data:
CDC Split Type: IA07013

Write-up: 10/7/07 Slight temp, nausea, course Lung sounds @ 2:30pm 10/7/07 3:30p elevated temp, labored breathing, cyanotic lips and finger tips. 10/7/07 4:00 resident transferred to hospital. 10/26/07 Hospital medical records reviewed which reveal patient experienced progressively worsening SOB. Admitted 10/7-10/9/2007. Exam revealed air hunger, rales, rhonchi. Initially improved w/pulmonary toilet & IV antibiotics & IV steroids. Deteriorated & expired. No autopsy done. FINAL Dx: bilateral pneumonia, presumably bacterial, unknown organism; and pulmonary fibrosis. 11/27/07 Reviewed death certificate which states COD as pneumonia due to chronic interstitial lung disease.


VAERS ID: 294274 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2007-10-20
Onset:2007-10-20
   Days after vaccination:0
Submitted: 2007-10-24
   Days after onset:4
Entered: 2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78476 / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Death, Syncope, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-22
   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:
Current Illness: This was a Public Health Mass Immunization clinic. This patient does not come here for routine care. We know that he had had flu vaccine in the past, has a GI upset reaction to eaten eggs, but still eats them, and reported no febrile illness in the 48 hours prior to vaccination and was not allergic to thimerisol
Preexisting Conditions: Discussion with cardiologist listed above revealed that the patient was under his care for "a significant heart condition" and that the doctor does not believe that the immunization contributed to the patient''s demise. He stated that if the patient had been in his office, his risk factors would have warranted vaccination with influenza vaccine. PMH: ischemic cardiomyopathy, ejection fraction 20%; CHF class 2-3; ventricular tachycardia; chronic renal insufficiency; multiple CVAs; COPD; PVD; chronic pain. PMH: MI, HTN, CABG x 5, cardiac stents, pacemaker. Abdominal aneurysm.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s daughter called after the event and reported that patientexperienced wheezing, cough and syncope "later that day" after he returned home from flu clinic. She did not indicate which, if any, hospital he was taken to, but that she had called his physician. Cardiologist. She reported that her father died on Sunday 10-21-2007 11/6/07 Received hospital clinic & cardiology medical records which reveal patient experienced CAD, s/p CABG (1982 & 1990) & severe LVD s/p ICD biventricular deployment; chronic back problems; hyperlipidemia; diabetes type 2; & controlled HTN. Cardiac cath of 4/2006 revealed patent left internal mammary arter to LAD bypass graft w/other grafts being occluded. Had been hospitalized 7/07 for pacemaker device discharge. Had DOE at that time. Pacer rate was increased due to myocardial ischemia. Developed chest pain, nausea & additional DOE. Dx w/unstable angina 7/11/07 & admitted to hospital. 1/18/08 Reviewed ER records of 10/22/07 which reveal patient fell & had witnessed cardiac arrest at home 50 min prior to arrival in ER. Had been intubated & IV access placed in field. ECG revealed V-fib & then asystole & patient expired 10/22/07. 1/29/08 Cardiac arrest per death certificate.


VAERS ID: 294509 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Tennessee  
Vaccinated:2007-10-08
Onset:2007-10-09
   Days after vaccination:1
Submitted: 2007-10-26
   Days after onset:17
Entered: 2007-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941U / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Autopsy, Body temperature increased, Death, Pulse absent, Respiratory arrest, Resuscitation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-09
   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: Acetaminophen 40mg given immediately after vaccinations. By report the family gave the same amount again at about 07:00pm on 10/08/2007.
Current Illness: None.
Preexisting Conditions: None.
Allergies:
Diagnostic Lab Data: Autopsy results pending.
CDC Split Type:

Write-up: Mother awakened in early morning and noticed that patient was not breathing or moving. Resuscitation attempted by father and by EMS and hospital personnel. By report, first recorded temperature during resuscitation was 102 F. Pulse was never reported to have been attained. 4/1/08 Autopsy report states COD as sudden unexplained infant death & manner of death not determined. Report states patient had recent URI. Found unresponsive on soft pillow on couch w/parent.


VAERS ID: 294842 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2007-10-18
Onset:2007-10-24
   Days after vaccination:6
Submitted: 2007-10-30
   Days after onset:6
Entered: 2007-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA294CA / 2 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Death, Lethargy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-24
   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: restoril 30 mg q HS, avadart 1 qD, ASA 81 mg q day, remeron 45 mg q HS, oxycodone ER 20 mg bid, magic cup 1-2 q day (nutritional supp given by oncology)deptestosterone 200 mcg IM biweekly, augmentin 875 mg bid
Current Illness: lung ca rul, chronic pneumonia rul due to partial obstruction
Preexisting Conditions: HTN, COPD, CAD, RUL lung CA, depression PMH: HTN, CAD, RUL SCCA of lung.
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 1 week after administration found dead at home. History of COPD and squamous cell lung cancer RUL with obstruction of airway and s/p palliative treatment. Daughter felt he became more lethargic 24 hours after vaccination and requested we report this. No autopsy performed by medical examiner and death certificate pending. 11/27/07 Reviewed death certificate which states COD as right lung pancoast tumor due to chronic obstructive pulmonary disease. 1/4/08 Reviewed medical records which reveal patient experienced cough, recurrent RUL infections which responded to antibiotic tx, RUE pain s/p brachial plexus involvement, poor appetite on 10/18/07. Dx w/RUL lung Pancoast squamous cell carcinoma, stage B & tx w/chemo & radiation tx.


VAERS ID: 294848 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2007-10-28
Onset:2007-10-29
   Days after vaccination:1
Submitted: 2007-10-30
   Days after onset:1
Entered: 2007-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLLA062AA / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-29
   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: omeprazol 20 mg daily, Zyprexa 2.5mg evening, ativan 0.25mg po twice daily, remeron 15mg po qhs
Current Illness: See # 19.
Preexisting Conditions: chronic ischemic heart disease. HTN, depression, A-fib. no known allergies. 11/2/07 Received medical records from reporter which reveal patient experienced a PMH: anxiety, depression, dementia, recurrent UTIs, CAD, atrial fib, MI, cataracts.
Allergies:
Diagnostic Lab Data: lot # aflla062aa
CDC Split Type:

Write-up: patient was not acutely ill but was found dead in her chair within 24 hours of flu vaccine. 1/15/08 Death certificate states COD as acute myocardial infarction w/chronic ischemic heart disease as contributing factor.


VAERS ID: 294850 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2007-10-26
Onset:2007-10-28
   Days after vaccination:2
Submitted: 2007-10-30
   Days after onset:2
Entered: 2007-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA062AA / UNK UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-28
   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: atenolol 12.5mg po daily, HCTZ 12.5mg po daily, omeprazole 20mg daily, glyberide 5mg twice daily, aggrenox sa 1 cap twice daily, hydralizine 10mg four times daily, lipator 20mg every pm, lasix 40mg daily. remeron 15mg po in pm, namenda 10 m
Current Illness: see # 19.
Preexisting Conditions: diabetes, HTN, SDAT, collitis PMH: Alzheimer''s, lipid disorder, BPH, TURP, prostate cancer, polypectomy, HTN, DM, bowel neoplasm, CVA 2004 requiring craniotomy & evacuation, CHF, ejection fraction 60% in 2003, first degree AV blockdiverticulosis, side branch IPMN, prostate cancer.
Allergies:
Diagnostic Lab Data: LABS: Sodium 131, BUN 45, creatinine 2.9. CXR pulmonary edema. KUB distended bowel loops. Amylase 108, lipase 31
CDC Split Type:

Write-up: Patient found dead in his chair 36 hours after vaccine. Had not been acutely ill prior to vaccination. 11/02/07 Received medical records from reporter which reveal patient w/extensive medical hx. H&P of 5/07 indicates had recent diarrhea, apple core lesion in mid to distal sigmoid colon, severe dementia, SOB & extremely poor appetite who had been admitted to hospital then transferred to LTC due to lethargy, fatigue & falls. Had cellulitis & inflammation of lower leg but afebrile on day of vax. Next day had congested productive cough w/green phlegm & vomiting. 10/28 had increased congestion, unresponsive w/dusky color. BP 89/66 & placed on O2 due to sats of 50-60%. Taken to hospital. 11/16/07 Received hospital ER medical records of 10/28/2007. FINAL ER DX: respiratory failure, sepsis Records reveal patient experienced fever, lethargy altered mental status & abdominal guarding. Exam revealed bilateral diffuse rhonchi, increased respiratory rate, diffuse abdominal tenderness & guarding, decreased bowel sounds, pitting edema of LE''s & tachycardia, temp 101.3. Patient was DNR & comfort measures provided until expiration. ME declined case.


VAERS ID: 295043 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2007-10-22
Onset:2007-10-22
   Days after vaccination:0
Submitted: 2007-10-31
   Days after onset:9
Entered: 2007-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2489MA / UNK RL / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Cyanosis, Death, Irritability
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-22
   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: Albuterol (2.5mg/3ml-Bullets) 3 ml BID or TID & PRN; Robinul (0.2mg/ml) 2 ml TID Prevacid SoluTab (15mg/tab) 1 tab BID(am & hs) Glycolax 2 tsp QD Children''s Tylenol 4ml Q4 hours PRN increased Temperature
Current Illness:
Preexisting Conditions: This child was in a program. He had a multitude of diagnoses and problems including interrupted development of white matter of the brain, seizures, arthryogryposis of CNS origin, cyanotic spells, apneic events, problems with thermoregulation, reflux, aspiration. He had a pacemaker implanted about a year ago and had been doing much better since then. Parents report he has not have a respiratory or cardiac arrest since then. He did still have seizures monthly. He had posturing and tics on a daily basis. He had an uncoordinated swallow and was at high risk for aspiration. I am the child''s nurse case manager and I have only been working with the family for about 4 months (the family was transferred to me due to internal staff reassign-ments). I reported his death to the State as required. I don''t know who administered the immunization. I don''t know if nurse filed a VAERS. Dr. was not in the office due to his father being in intensive care. The family reports patient had flu shots in the past without difficulty. I spoke with Dr. because I felt a VAERS was warranted. She gave me information and the website info and I am submitting this form today. I will be out of my office for about 3 weeks starting Sunday, November 4. In my absence, you may speak with my program''s director. She is aware that I have filed this report. PMH: early ROM w/decreased amniotic fluid & subsequent joint contractures. Medically fragile w/multiple conditions including severe GERD. Multiple malformations of brain with developmental delay. Recurrent episodes of apnea & structural compromise of airway.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child had flu shot @ about 10 am. Waited in office for 20 minutes. Went home w/mother and private duty nurse. Nurse reported he was fussy after the immunization. She held him until he went to sleep. They put child to bed in parental bedroom upstairs. Nurse went to kitchen to get g-tube feeds ready. Apnea alarm went off shortly thereafter. When RN got to the child, he was face down in the bed and blue. They administered CPR, called 911. He was airlifted to hospital, where he was pronounced dead approximately two hours after receiving the flu shot. 11/13/07 Received autopsy report which reveals COD as complications of cerebral dysgenesis of indeterminate etiology; arthrogryposis multiplex congenita was a significant contributing factor. Had been placed on side for nap but was found prone. Disabilities rendered unable to lift head/body to protect airway. 11/16/07 Received vax records from pcp. VAERS database updated w/same.


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