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This is VAERS ID 487759

Case Details

VAERS ID: 487759 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Male  
Location: New Jersey  
   Days after vaccination:4
Submitted: 2013-03-25
   Days after onset:13
Entered: 2013-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Abdominal distension, Choking sensation, Computerised tomogram abdomen abnormal, Death, Dyspnoea, Ear infection, Gastrectomy, Gastric perforation, Gastrointestinal gangrene, General physical health deterioration, Guillain-Barre syndrome, Haemodialysis, Mechanical ventilation, Plasmapheresis, Post procedural complication, Pyrexia, Renal failure, Respiratory failure, Surgery, Upper gastrointestinal haemorrhage
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal perforation (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Cardiomyopathy (broad), Demyelination (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-03-21
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levofloxacin
Current Illness: No
Preexisting Conditions: Allergy to Sulfa drugs
Diagnostic Lab Data: As above
CDC Split Type:

Write-up: He started having high grade fever on 3/12, reaching up to 102.9. I asked him to go to his primary care physician who thought he had ear infection and prescribed Levofloxacin. He called me on 3/16/13 complaining of severe shortness of breath and choking sensation in the neck. He deteriorated over the next few days with worsening shortness of breath, persistent fever, renal and respiratory failure requiring hemodialysis and ventilator support. He also underwent a single course of plasmapharesis with presumed diagnosis of Guillain Barre Syndrome but did not respond. He had upper GI bleed and subsequent CT scan showed free air in the abdomen. He underwent emergency surgery that showed gastric gangrene and perforation. Total gastrectomy was performed. He had increasing abdominal distention post-surgically and passed away approximately 5 am on 3/21/2013.

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