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From the 11/12/2021 release of VAERS data:

This is VAERS ID 414511

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Case Details

VAERS ID: 414511 (history)  
Form: Version 1.0  
Age: 7.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2010-11-08
Onset:2010-12-19
   Days after vaccination:41
Submitted: 2011-01-11
   Days after onset:23
Entered: 2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501013P / UNK NS / IN

Administered by: Private       Purchased by: Private
Symptoms: Acute disseminated encephalomyelitis, Coma, Confusional state, Death, Lumbar puncture, Nuclear magnetic resonance imaging, Pyrexia, Subacute sclerosing panencephalitis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-01-02
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Peg Infron; Isoprinosine
Current Illness: SSPE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI & LP at Clinic and Hospital
CDC Split Type:

Write-up: ADEM secondary to agency from administration of live virus flu vaccine to patient following interferon confusion, fever, coma, death. Contact hospital doctor for details.


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