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From the 1/14/2022 release of VAERS data:

Found 2,964 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 34 out of 297

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VAERS ID: 485686 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Male  
Location: Colorado  
Vaccinated:2012-11-15
Onset:0000-00-00
Submitted: 2013-02-27
Entered: 2013-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Cardiac arrest, Death, Multi-organ failure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), 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), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-12-13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1302USA012087

Write-up: This spontaneous report as received from a consumer refers to an 82 year old male patient. The patient''s medical history and concurrent conditions were not provided. On 15-NOV-2012 the patient was vaccinated with a dose of ZOSTAVAX. Dose, route and lot number were not provided. No concomitant medications were reported. On an unknown date the patient experienced multi-organ failure and cardiac arrest. The outcome of multi-organ failure and cardiac arrest was reported as fatal. The patient died on 13-DEC-2012 at 1515 (military time) in the hospital. The cause of death was reported as cardiac arrest and multi-organ failure, according to the Death Certificate. No reporter causality was provided. Additional information has been requested.


VAERS ID: 485757 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: New York  
Vaccinated:2013-02-19
Onset:2013-02-19
   Days after vaccination:0
Submitted: 2013-02-25
   Days after onset:6
Entered: 2013-02-28
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB677CA / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H016238 / UNK UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U42927 / UNK UN / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U4431BA / UNK UN / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Cardiac arrest, Crying, Death, Endotracheal intubation, Respiratory arrest, Skin discolouration
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), 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), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-02-20
   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: DILANTIN; Phenobarb
Current Illness: Medical record - cough - resp sym x 5 days (doc denies)
Preexisting Conditions: Microcephaly; seizure
Allergies:
Diagnostic Lab Data: See reverse
CDC Split Type:

Write-up: 2/19/13 23:24 Pt brought in by ambulance in cardiac arrest, "mother states pt has been having cough & URI symptoms since 5 days - seen by doctor 2/19/13 & given 4 vaccines. Pt sleeping & crying - suddenly pt turned white & was not breathing - 911 called & intubated. Doctor states he was not aware of any illness & child''s DILANTIN level was 1.0. No lab found in medical record child revived & transfer to another hospital where child died on 2/20/13.


VAERS ID: 486413 (history)  
Form: Version 1.0  
Age: 49.0  
Sex: Female  
Location: Georgia  
Vaccinated:2012-09-14
Onset:2012-09-15
   Days after vaccination:1
Submitted: 2013-03-07
   Days after onset:173
Entered: 2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204601 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Abasia, Diarrhoea, Dysstasia, Hypersomnia, Hypokinesia, Intensive care, Lethargy, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2012-10-01
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: couldnt move without assistance~ ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|weakness~ ()~UN~12.75~Patient|~Influenza (Seas
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU
CDC Split Type:

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit.


VAERS ID: 487403 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Male  
Location: Florida  
Vaccinated:2013-03-07
Onset:2013-03-09
   Days after vaccination:2
Submitted: 2013-03-19
   Days after onset:9
Entered: 2013-03-21
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357 / UNK UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR H1123 / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 918175 / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-03-09
   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:
Current Illness:
Preexisting Conditions: The patient had been chronically ill with a history of T fistula with esophageal atresia which was repaired, traceomalacia, PDA (not specified) PFO (not specified), and cardiac issues.
Allergies:
Diagnostic Lab Data: Not reported
CDC Split Type: 201303977

Write-up: Initial report was received 11 March 2013 from a health care professional. A four-month-old male patient had received an injection of ACTHIB lot number UH609AA (corresponding sanofi pasteur SA lot number H1123-1), PEDIARIX (manufacturer GSK, lot number AC21B357 and PREVNAR (manufacturer Pfizer, lot number 918175) on 07 March 2013, and two days later on the evening of 09 March 2013, the patient passed away. He had previously received a first dose of RSV vaccine on an unspecified date. The patient had been chronically ill with a history of T fistula with esophageal atresia which was repaired, traceomalacia, PDA (patent ductus arteriosus), PFO (patent foramen ovale), and cardiac issues. He had no known allergies. The event outcome was fatal. Documents held by sender: None.


VAERS ID: 487601 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Male  
Location: Iowa  
Vaccinated:2013-03-20
Onset:2013-03-21
   Days after vaccination:1
Submitted: 2013-03-22
   Days after onset:1
Entered: 2013-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4335AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH774AB / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1604 / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F42899 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012979 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Death, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-03-21
   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: Maternal smoker - 1.5 ppd
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child was found unresponsive in crib on 3/21/13 am. Mom had fed at approx. 3 am and baby was fine. Found at 7 am face down in bassinet. 911 called. Pronounced dead at hospital.


VAERS ID: 487759 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2013-03-08
Onset:2013-03-12
   Days after vaccination:4
Submitted: 2013-03-25
   Days after onset:13
Entered: 2013-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH588AA / 1 UN / UN

Administered by: Private       Purchased by: Other
Symptoms: Abdominal distension, Choking sensation, Computerised tomogram abdomen abnormal, Death, Dyspnoea, Ear infection, Gastrectomy, Gastric perforation, Gastrointestinal gangrene, General physical health deterioration, Guillain-Barre syndrome, Haemodialysis, Mechanical ventilation, Plasmapheresis, Post procedural complication, Pyrexia, Renal failure, Respiratory failure, Surgery, Upper gastrointestinal haemorrhage
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal perforation (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Cardiomyopathy (broad), Demyelination (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-03-21
   Days after onset: 9
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: Levofloxacin
Current Illness: No
Preexisting Conditions: Allergy to Sulfa drugs
Allergies:
Diagnostic Lab Data: As above
CDC Split Type:

Write-up: He started having high grade fever on 3/12, reaching up to 102.9. I asked him to go to his primary care physician who thought he had ear infection and prescribed Levofloxacin. He called me on 3/16/13 complaining of severe shortness of breath and choking sensation in the neck. He deteriorated over the next few days with worsening shortness of breath, persistent fever, renal and respiratory failure requiring hemodialysis and ventilator support. He also underwent a single course of plasmapharesis with presumed diagnosis of Guillain Barre Syndrome but did not respond. He had upper GI bleed and subsequent CT scan showed free air in the abdomen. He underwent emergency surgery that showed gastric gangrene and perforation. Total gastrectomy was performed. He had increasing abdominal distention post-surgically and passed away approximately 5 am on 3/21/2013.


VAERS ID: 489391 (history)  
Form: Version 1.0  
Age: 10.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2012-12-01
Onset:2013-03-20
   Days after vaccination:109
Submitted: 2013-04-15
   Days after onset:26
Entered: 2013-04-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain upper, Cardiac arrest, Chest pain, Death, Dyspnoea, Influenza, Life support, Myocarditis, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-04-05
   Days after onset: 16
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: Not reported
Allergies:
Diagnostic Lab Data: Not reported
CDC Split Type: 201304714

Write-up: Initial report was received on 08 April 2013 from an electronic lay press article. A 10-year-old female patient had received an injection of INFLUENZA VACCINE (trade name, manufacturer, lot number, route, site and exact date of administration not reported) in December 2012. The patient was diagnosed with strain B flu on 20 March 2013. Three days after the patient was diagnosed with the flu, she was rushed to the hospital after complaining of stomach and chest pains and difficulty breathing. She went into cardiac arrest the following morning, and doctors revived her after performing CPR for about two hours. She was placed on a life support system to restore oxygen to her blood. Doctors also put her on a machine to do the work of her heart while waiting for a transplant. The infection morphed into a serious case of myocarditis. The patient died from flu complications at 10:45 AM on 05 April 2013. Outcome was fatal. Documents held by sender: none.


VAERS ID: 489579 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2012-11-21
Onset:2013-03-15
   Days after vaccination:114
Submitted: 2013-04-18
   Days after onset:34
Entered: 2013-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. H018093 / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: CSF test abnormal, Creutzfeldt-Jakob disease, Ear congestion, Electroencephalogram abnormal, Erythema, Neurological symptom, Nuclear magnetic resonance imaging abnormal, Sinus congestion, Terminal state
SMQs:, Anaphylactic reaction (broad), Dementia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2013-04-25
   Days after onset: 41
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: Albuterol, Fluticasone nasal spray, glucosamine, B complex vitamin, Levothyroxine, Lipitor, Omega-3 FA, Singulair, Zyrtec
Current Illness: No
Preexisting Conditions: Hyperlipidemia
Allergies:
Diagnostic Lab Data: MRI, EEG, CSF evaluation all diagnostic of Creutzfeld Jacob Disease.
CDC Split Type:

Write-up: This is a concern given the timing of the onset of the second disease. There is no proof of any association but I feel that the condition is so rare that the timing of the Zostavax vaccination needs to be at least mentioned. The patient and her husband received Zostavax injections in Nov 2012. The patient developed a small localized erythematous reaction but her husband developed a full shingles reaction/rash to his right forehead which then cleared without event. In late January 2012 the patient started coming in with complaints about fullness in her ears, sinus congestion. She was treated with antibiotics and finally prednisone. While on prednisone she started to develop neurologic deficits in 3-15-13 that eventually progressed into major neurologic deficits and finally the diagnosis of Creutzfeld-Jacob Disease via MRI, EEG, and CSF evaluation. The patient is receiving comfort care at home as I write this and is expected to die within the next week. I am just concerned about the timing of the vaccination and then onset of symptoms and then diagnosis of CJD within 5 months.


VAERS ID: 489865 (history)  
Form: Version 1.0  
Age: 0.16  
Sex: Female  
Location: Kentucky  
Vaccinated:2013-04-22
Onset:2013-04-23
   Days after vaccination:1
Submitted: 2013-04-23
   Days after onset:0
Entered: 2013-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4360AA / 2 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHHVC188CA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57197 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012974 / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Breath sounds abnormal, Crying, Eye movement disorder, Hypotonia, Lip disorder, Respiratory arrest, Respiratory tract congestion, Resuscitation, Skin discolouration, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-04-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 15mg/ 1ml 1 ml BID
Current Illness:
Preexisting Conditions: Jaundice, GERD.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 9:02 am mother called and was worried about pt''s lip doing a funny thing, immediately spoke to mother concerning pt, and stated that pt''s lip had been doing something funny and had been crying and sounded a little congested and rattling, but had received shots yesterday and been put on Zantac for reflux, pt''s eyes had not been moving, but now were closed she thought she was tired from crying, noticed earlier that her forehead looked purple but better now and her buttocks looked a little purple but didn''t know why, stated her lip was getting better now, but her brother had tried saying her names but pt. did not focus her eyes on him just looked straight ahead, asked if pt was having distressed breathing and mom stated no, breathing fine, advised mom to bring pt. now to see Dr. and have pt looked at, ask pt. again if pt was having any distressed breathing, mom stated no, mother called back after getting off the phone with her at approximately 9:05am, mom called back 2 approximately 2 minutes after hanging up with her and told me that baby was not breathing and limp, advised to call 911 and told me she had, told her to start CPR, mom stated already had started CPR, wanted to know how many compressions, told mom 15 compressions with 2 breaths, advised papaw was doing breaths and she was doing compressions, advised to keep doing CPR till ambulance arrived, mom stated looked like the stomach was rising, keep doing CPR don''t stop, ask her to check for pulse, explained to where to check for pulse on infant, brachial pulse, but stated she was trying but couldn''t feel anything, advised keep doing CPR, don''t stop, the nurses here again called for an ambulance and told us they were 2 in route but didn''t know where they were located at, advised keep doing CPR, mom stated thought she heard some gargling, Dr took over phone call.


VAERS ID: 489874 (history)  
Form: Version 1.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2012-04-01
Onset:2013-04-02
   Days after vaccination:366
Submitted: 2013-04-23
   Days after onset:21
Entered: 2013-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / IM

Administered by: Public       Purchased by: Private
Symptoms: Exposure during pregnancy, Foetal death, Ultrasound scan
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-04-02
   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: N/A
Current Illness: NO
Preexisting Conditions: PREGNANCY
Allergies:
Diagnostic Lab Data: ULTRASOUND, DELIVERY
CDC Split Type:

Write-up: FETAL DEATH.


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