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From the 6/11/2021 release of VAERS data:

This is VAERS ID 407037



Case Details

VAERS ID: 407037 (history)  
Form: Version 1.0  
Age: 23.0  
Sex: Female  
Location: Michigan  
Vaccinated:2010-10-08
Onset:2010-10-11
   Days after vaccination:3
Submitted: 2010-11-05
   Days after onset:25
Entered: 2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3580CA / 5 LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Chest X-ray normal, Condition aggravated, Convulsion, Influenza A virus test positive
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-10-20
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Is on: Trilepta Albuterol Pulmicort
Current Illness: No
Preexisting Conditions: Developmental Delay Obstructive Sleep Apnea Seizure Disorder Prior History of Aspiration Pneumonia Dysphasia
Allergies:
Diagnostic Lab Data: Nasal Washing showed positive for Influenza A
CDC Split Type:

Write-up: Mom states patient had 2 minute seizure and then another one a little bit later that lasted about 5 minutes. She states she hasn''t had a seizure for about 4 to 5 months. Took her into ER per ambulance at 2:30am. Left ER 5:30am. Called ambulance again when she had a 35 minute seizure around 9:30am. Had chest x-ray earlier which was clear. Her Trilepta dosage was increased and she was sent home again.


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