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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 4 out of 310

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VAERS ID: 295076 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: Georgia  
Vaccinated:2007-10-29
Onset:2007-10-29
   Days after vaccination:0
Submitted: 2007-10-30
   Days after onset:1
Entered: 2007-10-31
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB163AB / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Abnormal behaviour, Cardiac arrest, Convulsion, Death, Respiratory failure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Systemic lupus erythematosus (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), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2007-10-30
   Days after onset: 1
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: None
Current Illness: None
Preexisting Conditions: None PMH: small child, picky eater, eczema, URI at 3 mos,
Allergies:
Diagnostic Lab Data: ER LABS: CXR revealed fine ground glass opacity throughout & numerous air bronchograms bilaterally. Hospital LABS: Head CT showed diffuse loss of gray-white differentiation, bilateral cerebral infarction w/herniation, indicating global hypoxic/ischemic event. Echocardiogram revealed severe LV dysfunction, septal posterior & anterior wall hypokinesis. Ejection fraction of 26%. CXR showed perihilar edema. PT/PTT very prolonged. PCP LABS: lead <3 10/05, Hgb 13.3 (N) 10/05, RSV (+) 12/04.
CDC Split Type:

Write-up: Approx. 45 min after injection, mother noted child was not acting correctly and returned to the office with him. He was noted to be having a seizure and was transported to the hospital where he suffered resp. failure and cardiac arrest. He is currently on life support. Died 10-30-07. 5/16/08 Autopsy report states COD as sudden unexplained child death associated w/acute pneumonia. Autopsy findings include: hypoxic-ischemic encephalopathy; wide spread acute pneumonia; phenytoin & lorazepam; no trauma. Patient had witnessed seizure followed by respiratory distress, intubation & subsequent cardiac arrest. Short hospitalization & expired despite therapeutic intervention. 11/1/07 Received medical records from CDC which reveal patient experienced shaking & unresponsive behavior after being seen in pcp office for vax. Returned to pcp & exam revealed patient having right sided seizure w/eyes deviated to right & right extremity twitching. Taken to ER after seizing for approx 15-20 min. Received 2 doses of ativan, intubated, received versed, paralytics, Pb, epi, bicarb, mannitol, lasix, solumedrol & atropine along w/IVF. Transferred by flight to higher level of care. 11/2/07 Received hospital medical records from CDC which contain PICU Death Summary. Reveals patient admitted s/p seizure & cardiac arrest. Multiple episodes of ventricular fibrillation, lidocaine & defibrillation during transport from outlying ER. Arrived at hospital hypotensive w/weak femoral pulses & quickly coded again for approx 5 min & pulse returned. BP maintained on epi drip until brain death pronounced. 11/6/07 Reveiwed pcp medical records from CDC which confirm dose & lot # as reported. Patient reported to be in usual state of health on day of vax but a little sleepy & cranky. Returned to office approx 45 min s/p vax with patient having right sided seizure w/eyes deviated to right. Office unable to obtain ativan, taken to ER, given O2 & IM ativan, then IV ativan when IV access obtained. Seizure stopped w/n 4 min & patient became apneic & was intubated. Stable for aprox 30-40 min then O2 sat dropped, bradycardia & then asystole. CPR started. Remained asystolic for approx 1 hour & then regained pulse. Developed ventricular fibrillation on the way to the helicopter & was converted back in ER. Then transported to higher level of care.


VAERS ID: 295195 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: Michigan  
Vaccinated:2007-10-31
Onset:2007-11-01
   Days after vaccination:1
Submitted: 2007-11-01
   Days after onset:0
Entered: 2007-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2459LB / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-11-01
   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: Fetal Omphalocele
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client passed away today. Cause of death unknown at this time. An autopsy is to be performed down state. 8/18/09 Autopsy report 11/02/06. Additional information abstracted: Medical complications of omphalocele. History of repair of congenital omphalocele. Severe abdominal adhesions with extensive dilation of loops of small and large intestine. Status post gastrostomy tube placement. Acute proximal and distal convoluted tubular necrosis of kidneys. Extensive intersitial calcification of kidneys.


VAERS ID: 295504 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Female  
Location: Maine  
Vaccinated:2007-11-02
Onset:2007-11-02
   Days after vaccination:0
Submitted: 2007-11-05
   Days after onset:3
Entered: 2007-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2502AA / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-11-02
   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:
Current Illness: Arthritis; HTN
Preexisting Conditions: Arthritis; HTN
Allergies:
Diagnostic Lab Data: ? Possible adverse reaction vs. M.I. LABS: EKG revealed acute inferior STEMI
CDC Split Type: ME01207

Write-up: On 11-02-2007 during routine office visit for arthritis and HTN, Flu vaccine given. Pt left the office with no c/o any. She went to shop and few hours later she was brought back in lethargic condition. O2 - 4 Epipen - applied, 911 - called, and she was transported by ambulance to Emergency Room. 12/11/07 Reviewed hospital ER records & death summary which reveal patient experienced severe substernal chest pain & collapsed while shopping 11/2/2007. EMS took to ER where she developed complete heart block & bradycardia. Tx w/meds, pacemaker & intubation. Resuscitated & taken for cardiac cath. In cath lab, arrested & CPR started. Developed ventricular fibrillation non responsive to defibrillation & meds & pronounced. 1/11/08 Received death certificate which states COD as ventricular fibrillation, acute MI & ateriosclerotic heart disease.


VAERS ID: 296073 (history)  
Form: Version 1.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2007-10-23
Onset:2007-10-23
   Days after vaccination:0
Submitted: 2007-11-09
   Days after onset:17
Entered: 2007-11-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 78478 / UNK UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-23
   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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MA20071247

Write-up: We received from a health care professional via the agency following information on 29 OCT 2007: A 89-year-old man, born on 15 JUL 1918, was vaccinated with Fluvirin, batch-no. 78428, i.m. on 23 OCT 2007. The patient died shortly after the vaccination after he left the facility and walked down the hall. Caller felt that individual was properly screened, reported no allergies to any component, and filled out the waiver for the vaccine prior to administration, and had prior flu vaccinations. The reporter felt the death was coincidental based on the age and history of the patient. Company assessment: Seriousness criterion: death. Causality: insufficient data. Expectedness assessment according to manufacturer label: Death after Fluvirin is not expected. No change in benefit-risk-ratio. No measure necessary. Addendum We received from a health care professional via the medical agencies additional information on 29 OCT 2007: The batch-no. was 78478 (and not 78428 as previously reported). No change in assessment. NA07-005622


VAERS ID: 296075 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Kentucky  
Vaccinated:2007-10-29
Onset:2007-10-30
   Days after vaccination:1
Submitted: 2007-10-30
   Days after onset:0
Entered: 2007-11-08
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2607AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1158F / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21009 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 853981 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 05084 / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-30
   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: Nystatin
Current Illness: constipation, thrush
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death. 12/17/07 Reviewed autopsy report which states COD as SIDS. Patient found in crib lying on back & unresponsive. 12/17/07 Received vax record & medical records which confirm vax dose & lot #s as reported. Patient had thrush & was constipated during office visit 10/29/07, otherwise, healthy.


VAERS ID: 296120 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2007-10-09
Onset:2007-10-21
   Days after vaccination:12
Submitted: 2007-11-08
   Days after onset:18
Entered: 2007-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2464AA / UNK UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Back pain, Blood pressure increased, Body temperature increased, Electromyogram abnormal, Guillain-Barre syndrome, Intubation, Lumbar puncture, Muscular weakness, Plasmapheresis, Respiratory failure
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (narrow), Neuroleptic malignant 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), Acute central respiratory depression (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Demyelination (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2007-11-25
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 32 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nexium, Ambien, Lisinopril, Hydrochlorothiazide, Taztia XT, Aspirin, Doxazosin, Alprazolam, Tylenol #3.
Current Illness: none 12/17/07-records received-Headache which lasted over the last few weeks.
Preexisting Conditions: Hypertension, Coronary Artery Disease, Gastroesophageal Reflux Disease, Osteoarthritis, Atrial Fibrilation. 12/17/07-records received-PMH: coronary artery disease. Hypertension. Atrial fibrillation. Gastroesophageal reflux disease. Osteoarthritis. Insomnia.
Allergies:
Diagnostic Lab Data: Contrast MRI, Spinal tap, prolonged F wave response 12/17/07-records received- Lumbar puncture showed cyto-albuminic disassociation, elevated protein and enhancement of lumbar roots on MRI. D-dimer elevated at 766. Increased segmented neutrophils 72%. Abdominal and pelvic CT normal. CT head showed small possible meningioma in left occipital parietal area not causing any of his problems. EMG F waves consistent with Guillain-Barre syndrome.
CDC Split Type:

Write-up: Patient is suffering from Guillain Barre Syndrome. The patient presented about 9 days after flu vaccine administration with symptoms of weakness in his lower extremities and lower back pain. The patient is currently intubated due to respiratory failure and has had 5 days of high dose IV immunoglobulin with no improvement. The patient is finishing his last round of plasmapharesis in the next day. During his time at the hospital he experienced elevated blood pressure which was hard to treat, he also had an increased core temperature for a couple of days. 12/17/07-records received for DOS 10/22-11/25/07-DC DX: Guillain-Barre syndrome. Persistent encephalopathy seconary to Guillain-Barre syndrome. Respiratory failure requiring mechanical ventilation. Death. Presented to ED with severe back pain with increasing weakness. Back pain started on 10/21/07-Low back pain with some numbness and tingling in legs. Today unable to get up. PE: mild quadriparesis along with mild sensory changes at distal extremities.Treated with IVIG. 5/15/09 Death certificate states COD as respiratory failure due to Guillain Barre syndrome.


VAERS ID: 296231 (history)  
Form: Version 1.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2007-10-17
Onset:2007-11-01
   Days after vaccination:15
Submitted: 2007-11-06
   Days after onset:5
Entered: 2007-11-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500486P / UNK NS / IN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2758AA / UNK LA / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-11-01
   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: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200703735

Write-up: A 25-year-old patient, with no reported concurrent illnesses, pre-existing medical conditions, or use of other medications, had received a left deltoid (route not provided) dose of Adacel (lot number C2758AA), and a dose (route not provided) of FluMist (manufacturer MedImmune) (lot number 500486P) on 17 October 2007. Fifteen days post-vaccinations, on 01 November 2007, the patient expired in his sleep. At the time of the report, the autopsy was not complete. No cause of death has been determined at this time. 12/14/07 Received vax record from provider which confirms lot #s as reported. 1/18/08 Reviewed autopsy report which states COD as idiopathic mitral prolapse. Findings at autopsy included: enlarged dilated heart w/LVH & clean coronaries; parachute deformity w/hooding of anterior mitral cusp & lengthening of the chordae tendineae w/mild white thickening of the septal endocardim behind mitral valve; hyperinflated lungs; pneumomediastinum; enlarged liver/spleen/hepatic portal lymph nodes.


VAERS ID: 296240 (history)  
Form: Version 1.0  
Age: 94.0  
Sex: Female  
Location: Michigan  
Vaccinated:2007-10-03
Onset:2007-10-06
   Days after vaccination:3
Submitted: 2007-11-06
   Days after onset:31
Entered: 2007-11-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 79489 / UNK LA / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-06
   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
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Unknown 11/16/07 Reviewed death certificate which reveals COD as liver cancer.


VAERS ID: 296690 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2007-10-10
Onset:2007-10-15
   Days after vaccination:5
Submitted: 2007-10-27
   Days after onset:12
Entered: 2007-11-14
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH AFLLA037AA / UNK LA / -

Administered by: Private       Purchased by: Other
Symptoms: Cardiac failure, Death, Vaccination complication, Viral infection
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-27
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UPPER RESPRITORY VIRAL INFECTION
Preexisting Conditions: PMH: mitral valve replacement 1996 w/recent coumadin change, rheumatic fever, CVA x 2-3, HTN, Type 2 DM, CHF, mitral valve stenosis allergy to phenobarbital.
Allergies:
Diagnostic Lab Data: LABS: WBC 18.3 (H), segs 81%(H), monos 3% (L), lymphs 16% (L), platelets 482 (H). CK 24, CKMB 17.8, troponin neg. AST 37, LDH 234. PT/PTT 17.6/26l6, INR 2.0. Dig level 1.0. Blood glucose 451(H), K 5.4 (H), BUN 28 (H), creat 1.3, Cl 93 (L), CO2 16.7 (L), NA 130 (L). CXR revealed cardiomegaly, mild failure w/minimal bilateral perihilar infiltrates. Repeat CXR revealed increased failure w/diffuse pulmonary edema & bilateral infiltrates suggesting aspiration pneumonia.
CDC Split Type:

Write-up: oct.28.2007 treated for upper respritory viral infected.sept.10 2007recieved influensa vaccine.sept.17 2007treated for viral infection complecated by influensa vaccine.oct.27 2007died heart failer complecated by virial infection 11/16/07 Reviewed vaccine record from pcp & VAERS database updated w/same. 11/27/07 ER Final dx: cardiac arrest, expired. Reviewed hospital medical records which reveal patient experienced chest & left arm pain, cold & clammy, skin mottled, nauseated, felt faint & passed out when EMS arrived. EMS rhythm strip revealed BBB w/ST segment depression. In ER, vomited & had diarrhea. EKG revealed atrial fib w/rapid ventricular response. DX w/acute bronchitis & atrial fib w/RVR. Became unresponsive & developed cardiac arrest. Resuscitated & intubated. While being tansferred to higher level of care via helicopter, coded again. Returned to ER & unable to resuscitate. 3/7/2008 Judge states he signed death certificate as directed by state law when patient is not in hospital & only seen in ER but paper copy no longer available. States COD as undetermined & manner of death natural. 3/11 Death certificate reviewed & states COD as undetermined & manner of death as natural.


VAERS ID: 297079 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Kentucky  
Vaccinated:2007-11-08
Onset:2007-11-12
   Days after vaccination:4
Submitted: 2007-11-13
   Days after onset:1
Entered: 2007-11-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B046AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0500U / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702H / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-11-12
   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: None
Current Illness: None
Preexisting Conditions: 34 weeks gestation
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: received phone call that infant had expired. 2/5/08 Reviewed Autopsy Report & death certificate which accompanied autopsy report which states COD consistent w/Sudden Infant Death Syndrome (Group B) in co-sleeping infant. Findings included: sudden death in 2 mo old co-sleeping infant; hx of parental drug abuse (opiates per parents); post mortem tox exam neg for drugs or alcohol; hx of preemie, 36 wk, 5 lbs, 4 oz.


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