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This is VAERS ID 467247

Case Details

VAERS ID: 467247 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: New York  
Vaccinated:2012-09-26
Onset:2012-09-27
   Days after vaccination:1
Submitted: 2012-10-02
   Days after onset:5
Entered: 2012-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AA / 4 AR / IM

Administered by: Private       Purchased by: Public
Symptoms: Body temperature increased, Death, Moaning, Nasal flaring, Pain, Peripheral coldness, Resuscitation
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-09-27
   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: Multivitamin Levetiraceta Phenobarbitol Diazepam
Current Illness: None
Preexisting Conditions: MR/CP, seizure disorder, developmental delay
Allergies:
Diagnostic Lab Data: None. Family waived Medical Examiner review.
CDC Split Type:

Write-up: 11AM-O2 sats @74%, HR 204, temp 97.7, moaning, upper extremities cold. Tylenol given for pain. 1:10PM-nasal flaring, O2 sats @ 74%, HR 82, temp 99.9, RR 42. EMS called and subsequent code blue. Chest compressions and ambu-bagged, epinephrine given. Transferred to hospital. Pronounced dead at hospital.


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