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From the 4/30/2021 release of VAERS data:

This is VAERS ID 379507



Case Details

VAERS ID: 379507 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Male  
Location: Indiana  
Vaccinated:2010-01-21
Onset:2010-01-21
   Days after vaccination:0
Submitted: 2010-02-04
   Days after onset:14
Entered: 2010-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 102135P1 / UNK - / IJ

Administered by: Other       Purchased by: Public
Symptoms: Death, Eating disorder, Hypotonia, Lethargy, Parkinson's disease
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-01-25
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro tab 10 mg Amitiza Caps 24mcg Nasonex Scent Free Ns Spr 17g 50mcg Omeprazole Caps 20mg Requip Tabs 0.25mg Xalatan Opth Soln 2.5ml 0.005% Carbidopa/levodopa Tabs 25/100mg Megestrol Oral Susp 40mg/ml
Current Illness: Parkinson''s Disease
Preexisting Conditions: Parkinson''s Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lethargic, stopped drinking, stopped eating on the 21st. On the 22nd his arms layed limp at his sides when previously they were rigid and locked from the Parkinson''s. He would not eat or drink on the 22nd.


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