National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 5/7/2021 release of VAERS data:

This is VAERS ID 839106



Case Details

VAERS ID: 839106 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Male  
Location: Idaho  
Vaccinated:2019-10-01
Onset:2019-10-01
   Days after vaccination:0
Submitted: 2019-10-08
   Days after onset:7
Entered: 2019-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 2277M / 1 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Death, Incoherent, Lethargy, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2019-10-01
   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: Abilify, fluoxetine
Current Illness:
Preexisting Conditions: Cerebral palsy, Generalized anxiety disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. presented to clinic (Urgent Care) with mom on 10/1/19 at approx. 1945. He was lathargic, responsive to sternal rub, nonverbal and incoherent. 911 was called, pt. was taken by ambulance to the ED. Pt passed away on the evening of 10/1/19.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=839106


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166