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This is VAERS ID 418868

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/13/2011

VAERS ID: 418868
VAERS Form:
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 0 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Anuria, Aspartate aminotransferase increased, Blood albumin decreased, Blood calcium decreased, Blood creatinine increased, Blood gases abnormal, Blood glucose increased, Blood immunoglobulin A decreased, Blood immunoglobulin G decreased, Blood immunoglobulin M decreased, Blood potassium decreased, Blood sodium decreased, Blood urea increased, Bradycardia, Carbon dioxide decreased, Chest X-ray abnormal, Chills, Cough, Death, Glomerular filtration rate decreased, Haematocrit decreased, Blood urine present, Haemoglobin decreased, Hypotension, Hypoxia, International normalised ratio increased, Lung infiltration, Lymphocyte count increased, Malaise, Mean cell haemoglobin concentration decreased, Nausea, Neutrophil count increased, Pain, Platelet count decreased, Pneumonia, Protein total decreased, Prothrombin time prolonged, Pyrexia, Renal failure acute, Urinary casts, Urine abnormality, White blood cell count increased, Neutrophil percentage decreased, Monocyte percentage decreased, Lymphocyte percentage increased, Respiratory tract congestion, Protein urine present, Red cell distribution width increased, Bacterial test positive, Antibody test abnormal, Mechanical ventilation, Endotracheal intubation, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 5/13/2011

VAERS ID: 418868 Before After
VAERS Form:
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 0 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Anuria, Aspartate aminotransferase increased, Blood albumin decreased, Blood calcium decreased, Blood creatinine increased, Blood gases abnormal, Blood glucose increased, Blood immunoglobulin A decreased, Blood immunoglobulin G decreased, Blood immunoglobulin M decreased, Blood potassium decreased, Blood sodium decreased, Blood urea increased, Bradycardia, Carbon dioxide decreased, Chest X-ray abnormal, Chills, Cough, Death, Glomerular filtration rate decreased, Haematocrit decreased, Blood urine present, Haemoglobin decreased, Hypotension, Hypoxia, International normalised ratio increased, Lung infiltration, Lymphocyte count increased, Malaise, Mean cell haemoglobin concentration decreased, Nausea, Neutrophil count increased, Pain, Platelet count decreased, Pneumonia, Protein total decreased, Prothrombin time prolonged, Pyrexia, Renal failure acute, Urinary casts, Urine abnormality, White blood cell count increased, Neutrophil percentage decreased, Monocyte percentage decreased, Lymphocyte percentage increased, Respiratory tract congestion, Protein urine present, Red cell distribution width increased, Bacterial test positive, Antibody test abnormal, Mechanical ventilation, Endotracheal intubation, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 6/14/2014

VAERS ID: 418868 Before After
VAERS Form:
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 0 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 2/14/2017

VAERS ID: 418868 Before After
VAERS Form:
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 0 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 9/14/2017

VAERS ID: 418868 Before After
VAERS Form:(blank) 1
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 0 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 2/14/2018

VAERS ID: 418868 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 6/14/2018

VAERS ID: 418868 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 8/14/2018

VAERS ID: 418868 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 9/14/2018

VAERS ID: 418868 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 10/14/2018

VAERS ID: 418868 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 12/24/2020

VAERS ID: 418868 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 12/30/2020

VAERS ID: 418868 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 5/7/2021

VAERS ID: 418868 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.


Changed on 5/21/2021

VAERS ID: 418868 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Montana
Vaccinated:2011-02-10
Onset:2011-02-10
Submitted:2011-03-16
Entered:2011-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52BO67GA / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Death, Malaise, Nausea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2011-02-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pradaxa 150 mg daily Lipitor 10 mg daily Lisinopril 20 mg daily Diltiazem 180 mg daily Hctz 12.5 mg daily Zyrtec 10 mg daily
Current Illness: None reported by the patient
Preexisting Conditions: Hyperlipidemia Chronic Lymphoid Leukemia Hypertension Atrial Fib Chronic allergic Rhinitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Tdap vaccine was givin in the clinic. The patient called on 2/15/2011 and reported that within 2-3 hours of the injection he was feverish, chilled, nauseated, had body aches, and chest congestion and overall felt very ill. Patient died on 2/20/2011 of an unusual strain of pneumonia.

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