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This is VAERS ID 843697

Case Details

VAERS ID: 843697 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2019-10-17
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2019-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR - / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Cardiac disorder (severely disabled with significant cardiac, respiratory and neurodevelopmental problems related to a genetic abnormality); Multiple congenital abnormalities; Neurodevelopmental disorder (severely disabled with significant cardiac, respiratory and neurodevelopmental problems related to a genetic abnormality); Respiratory disorder (severely disabled with significant cardiac, respiratory and neurodevelopmental problems related to a genetic abnormality)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AUSA2019SA295057

Write-up: respiratory progressing to cardiac arrest, was unable to be resuscitated; febrile after flu vaccine; child passed away; Initial information received on 24-Oct-2019 regarding an unsolicited valid serious case received from a physician. This case involves a eight months old male patient who experienced respiratory progressing to cardiac arrest, was unable to be resuscitated (cardio-respiratory arrest), febrile (pyrexia) and passed away, while he received vaccine INFLUENZA QUADRIVAL A-B VACCINE [FLUQUADRI JUNIOR]. The patient''s past medical history, medical treatment(s), vaccination(s) and family history were not provided. At the time of the event, the patient had ongoing condition: severely disabled with significant cardiac, respiratory and neurodevelopmental problems related to a genetic abnormality. 17-Oct-2019, the patient received a second dose of suspect INFLUENZA QUADRIVAL A-B VACCINE lot number not reported via unknown route in unknown administration site. On an unknown, the patient experienced a serious respiratory progressing to cardiac arrest, was unable to be resuscitated (cardio-respiratory arrest) (Unknown latency) following the administration of INFLUENZA QUADRIVAL A-B VACCINE. This event was assessed as medically significant. The patient was hospitalized for this event. On an unknown, the patient experienced a serious febrile after flu vaccine (pyrexia) (Unknown latency) following the administration of INFLUENZA QUADRIVAL A-B VACCINE. The patient was hospitalized for this event. On an unknown, the patient passed away due to unknown reason (death) (Unknown latency) following the administration of INFLUENZA QUADRIVAL A-B VACCINE. This event was assessed as medically significant and was leading to death. Other relevant tests were not reported. Final diagnosis was cardio-respiratory arrest, pyrexia and death. It was not reported if the patient received a corrective treatment. The patient outcome was reported as unknown for cardio-respiratory arrest and pyrexia. The patient had passed away due to unknown reason. It was unknown if an autopsy was done. The cause of death was not reported. The reporter assessed the causal relationship with suspect vaccine as possible. There will be no information available on the batch number for this case.; Sender''s Comments: This case concerns a eight months old male who presented with cardio-respiratory arrest and pyrexia one day after vaccination with FLUQUADRI JUNIOR and passed away. Patient''s medical condition includes multiple congenital abnormalities and was severely disabled with significant cardiac, respiratory and neurodevelopment problems related to a genetic abnormality. Origin of the fever was not reported nor lab tests. Autopsy results were not reported neither. Based upon the limited reported information, the role of the vaccine cannot be assessed; Reported Cause(s) of Death: child passed away


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