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This is VAERS ID 812406

History of Changes from the VAERS Wayback Machine

First Appeared on 8/14/2019

VAERS ID: 812406
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2018-10-30
Onset:2019-03-05
Submitted:0000-00-00
Entered:2019-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS AFLBA326AA / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Acute myocardial infarction, Cardiac failure, Coma, Culture throat, Death, Influenza, Pneumonitis, Respiratory failure, Sepsis, Vaccination failure, Polymerase chain reaction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-03-27
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin; Coumadin; Ramipril; Aliflus; Sertraline; HALCION; BRETARIS GENUAIR; BISOPROLOL FUMARATE; VASCOMAN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: PCR; Result Unstructured Data: Test Result: unknown, Test Result Unit: unknown
CDC 'Split Type': ITGLAXOSMITHKLINEIT201907

Write-up: Vaccination failure; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; This case was reported by a physician via regulatory authority and described the occurrence of vaccination failure in a 74-year-old female patient who received Flu Seasonal QIV Dresden (Fluarix Tetra 2018-2019 season) (batch number AFLBA326AA, expiry date unknown) for prophylaxis. Concomitant products included metformin hydrochloride (Metformin), warfarin sodium (Coumadin), ramipril, fluticasone propionate, salmeterol xinafoate (Aliflus), sertraline, triazolam (Halcion), aclidinium bromide (Bretaris Genuair), bisoprolol fumarate and manidipine hydrochloride (Vascoman). On 30th October 2018, the patient received Fluarix Tetra 2018-2019 season (unknown). On 5th March 2019, 126 days after receiving Fluarix Tetra 2018-2019 season, the patient experienced influenza a virus infection (serious criteria death), sepsis (serious criteria death and GSK medically significant), decompensation cardiac (serious criteria death and GSK medically significant), coma (serious criteria death and GSK medically significant), stemi (serious criteria death and GSK medically significant), respiration failure (serious criteria death and GSK medically significant) and pneumonitis (serious criteria death). On an unknown date, the patient experienced vaccination failure (serious criteria GSK medically significant). Fluarix Tetra 2018-2019 season was discontinued. On 27th March 2019, the outcome of the influenza a virus infection, sepsis, decompensation cardiac, coma, stemi, respiration failure and pneumonitis were fatal. On an unknown date, the outcome of the vaccination failure was unknown. The patient died on 27th March 2019. The reported cause of death was sepsis, decompensation cardiac, coma, stemi, pneumonitis, influenza a virus infection and respiration failure. It was unknown if the reporter considered the vaccination failure, influenza a virus infection, sepsis, decompensation cardiac, coma, stemi, respiration failure and pneumonitis to be related to Fluarix Tetra 2018-2019 season. Additional details: Age at vaccination was not reported however patient could be 73 or 74 years old at time of vaccination. On an unknown date PCR was performed with unknown results. Initial information was reported by a physician via regulatory authority on 1st May 2019. Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic heart failure. Reporter''s Comments: Laboratory tests performed: PCR on a throat swab. Sender''s Comments: "Waiting for the physician report." Lab Comments: On an unknown date, PCR was performed with unknown results.; Reported Cause(s) of Death: Sepsis; Decompensation cardiac; Coma; STEMI; Pneumonitis; Influenza A virus infection; Respiration failure


Changed on 12/24/2020

VAERS ID: 812406 Before After
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2018-10-30
Onset:2019-03-05
Submitted:0000-00-00
Entered:2019-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS AFLBA326AA / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Acute myocardial infarction, Cardiac failure, Coma, Culture throat, Death, Influenza, Pneumonitis, Respiratory failure, Sepsis, Vaccination failure, Polymerase chain reaction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-03-27
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin; Coumadin; Ramipril; Aliflus; Sertraline; HALCION; BRETARIS GENUAIR; BISOPROLOL FUMARATE; VASCOMAN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: PCR; Result Unstructured Data: Test Result: unknown, Test Result Unit: unknown
CDC 'Split Type': ITGLAXOSMITHKLINEIT201907

Write-up: Vaccination failure; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; This case was reported by a physician via regulatory authority and described the occurrence of vaccination failure in a 74-year-old female patient who received Flu Seasonal QIV Dresden (Fluarix Tetra 2018-2019 season) (batch number AFLBA326AA, expiry date unknown) for prophylaxis. Concomitant products included metformin hydrochloride (Metformin), warfarin sodium (Coumadin), ramipril, fluticasone propionate, salmeterol xinafoate (Aliflus), sertraline, triazolam (Halcion), aclidinium bromide (Bretaris Genuair), bisoprolol fumarate and manidipine hydrochloride (Vascoman). On 30th October 2018, the patient received Fluarix Tetra 2018-2019 season (unknown). On 5th March 2019, 126 days after receiving Fluarix Tetra 2018-2019 season, the patient experienced influenza a virus infection (serious criteria death), sepsis (serious criteria death and GSK medically significant), decompensation cardiac (serious criteria death and GSK medically significant), coma (serious criteria death and GSK medically significant), stemi (serious criteria death and GSK medically significant), respiration failure (serious criteria death and GSK medically significant) and pneumonitis (serious criteria death). On an unknown date, the patient experienced vaccination failure (serious criteria GSK medically significant). Fluarix Tetra 2018-2019 season was discontinued. On 27th March 2019, the outcome of the influenza a virus infection, sepsis, decompensation cardiac, coma, stemi, respiration failure and pneumonitis were fatal. On an unknown date, the outcome of the vaccination failure was unknown. The patient died on 27th March 2019. The reported cause of death was sepsis, decompensation cardiac, coma, stemi, pneumonitis, influenza a virus infection and respiration failure. It was unknown if the reporter considered the vaccination failure, influenza a virus infection, sepsis, decompensation cardiac, coma, stemi, respiration failure and pneumonitis to be related to Fluarix Tetra 2018-2019 season. Additional details: Age at vaccination was not reported however patient could be 73 or 74 years old at time of vaccination. On an unknown date PCR was performed with unknown results. Initial information was reported by a physician via regulatory authority on 1st May 2019. Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic heart failure. Reporter''s Comments: Laboratory tests performed: PCR on a throat swab. Sender''s Comments: "Waiting for the physician report." Lab Comments: On an unknown date, PCR was performed with unknown results.; Reported Cause(s) of Death: Sepsis; Decompensation cardiac; Coma; STEMI; Pneumonitis; Influenza A virus infection; Respiration failure


Changed on 12/30/2020

VAERS ID: 812406 Before After
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2018-10-30
Onset:2019-03-05
Submitted:0000-00-00
Entered:2019-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS AFLBA326AA / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Acute myocardial infarction, Cardiac failure, Coma, Culture throat, Death, Influenza, Pneumonitis, Respiratory failure, Sepsis, Vaccination failure, Polymerase chain reaction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-03-27
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin; Coumadin; Ramipril; Aliflus; Sertraline; HALCION; BRETARIS GENUAIR; BISOPROLOL FUMARATE; VASCOMAN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: PCR; Result Unstructured Data: Test Result: unknown, Test Result Unit: unknown
CDC 'Split Type': ITGLAXOSMITHKLINEIT201907

Write-up: Vaccination failure; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic hea; This case was reported by a physician via regulatory authority and described the occurrence of vaccination failure in a 74-year-old female patient who received Flu Seasonal QIV Dresden (Fluarix Tetra 2018-2019 season) (batch number AFLBA326AA, expiry date unknown) for prophylaxis. Concomitant products included metformin hydrochloride (Metformin), warfarin sodium (Coumadin), ramipril, fluticasone propionate, salmeterol xinafoate (Aliflus), sertraline, triazolam (Halcion), aclidinium bromide (Bretaris Genuair), bisoprolol fumarate and manidipine hydrochloride (Vascoman). On 30th October 2018, the patient received Fluarix Tetra 2018-2019 season (unknown). On 5th March 2019, 126 days after receiving Fluarix Tetra 2018-2019 season, the patient experienced influenza a virus infection (serious criteria death), sepsis (serious criteria death and GSK medically significant), decompensation cardiac (serious criteria death and GSK medically significant), coma (serious criteria death and GSK medically significant), stemi (serious criteria death and GSK medically significant), respiration failure (serious criteria death and GSK medically significant) and pneumonitis (serious criteria death). On an unknown date, the patient experienced vaccination failure (serious criteria GSK medically significant). Fluarix Tetra 2018-2019 season was discontinued. On 27th March 2019, the outcome of the influenza a virus infection, sepsis, decompensation cardiac, coma, stemi, respiration failure and pneumonitis were fatal. On an unknown date, the outcome of the vaccination failure was unknown. The patient died on 27th March 2019. The reported cause of death was sepsis, decompensation cardiac, coma, stemi, pneumonitis, influenza a virus infection and respiration failure. It was unknown if the reporter considered the vaccination failure, influenza a virus infection, sepsis, decompensation cardiac, coma, stemi, respiration failure and pneumonitis to be related to Fluarix Tetra 2018-2019 season. Additional details: Age at vaccination was not reported however patient could be 73 or 74 years old at time of vaccination. On an unknown date PCR was performed with unknown results. Initial information was reported by a physician via regulatory authority on 1st May 2019. Severe sepsis with coma and global respiratory failure due to multiple outbreak pneumonia and influenza A (despite vaccination), complicated by Non-ST elevation myocardial infarction and diastolic heart failure. Reporter''s Comments: Laboratory tests performed: PCR on a throat swab. Sender''s Comments: "Waiting for the physician report." Lab Comments: On an unknown date, PCR was performed with unknown results.; Reported Cause(s) of Death: Sepsis; Decompensation cardiac; Coma; STEMI; Pneumonitis; Influenza A virus infection; Respiration failure

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