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This is VAERS ID 845968

History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2020

VAERS ID: 845968
VAERS Form:2
Age:
Sex:Unknown
Location:Foreign
Vaccinated:2019-10-16
Onset:2019-10-18
Submitted:0000-00-00
Entered:2019-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (QIV DRESDEN) / GLAXOSMITHKLINE BIOLOGICALS AFLBA389CA / UNK - / OT

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-10-18
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: Folic acid; Novamin; Pantoprazole; TORASEMID; DEKRISTOL; RIVAROXABAN; OXYCODON
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiac failure (NYHA II); Osteoporosis; Pleural effusion; Pulmonary embolism (In September 2019, central, bds. to DVB T); Renal insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEGLAXOSMITHKLINEDE201919

Write-up: Pat. Deceased; This case was reported by a physician via regulatory authority and described the occurrence of unknown cause of death in a 87-year-old patient who received Flu Seasonal QIV Dresden (Influsplit Tetra 2019/2020) (batch number AFLBA389CA, expiry date unknown) for prophylaxis. The patient''s past medical history included pleural effusion, cardiac failure (NYHA II), renal insufficiency, pulmonary embolism (In September 2019, central, bds. to DVB T) and osteoporosis. Concomitant products included folic acid, amikacin sulfate (Novamin), pantoprazole, torasemide (Torasemid), colecalciferol (Dekristol), rivaroxaban and oxycodone (Oxycodon). On 16th October 2019, the patient received Influsplit Tetra 2019/2020 (unknown). On 18th October 2019, 2 days after receiving Influsplit Tetra 2019/2020, the patient experienced unknown cause of death (serious criteria death and GSK medically significant). On 18th October 2019, the outcome of the unknown cause of death was fatal. The patient died on 18th October 2019. The reported cause of death was unknown cause of death. It was unknown if the reporter considered the unknown cause of death to be related to Influsplit Tetra 2019/2020. Additional details: Age at vaccination was not reported however patient could be 86 or 87 years old at time of vaccination. Pleural effusion, cardiac failure (NYHA II), renal insufficiency, pulmonary embolism and osteoporosis were reported as current condition, However captured as historic condition since the patient was died. Initial information was reported by a physician via regulatory authority on 1st November 2019. Unknown cause of death. Sender''s comments: 1. In no case, on my part, is the concrete suspicion of a connection between death and the flu vaccine. There were no symptoms of allergic reaction or feverish infections. 2. Experience has shown that significantly more nursing home patients die off in the fourth quarter than in the other quarters. In the fourth quarter of 2018, 8 out of the 92 patients under my care died. 3. The number of 5 deceased patients (out of a total of 82 home patients) within 2 weeks.; Reported Cause(s) of Death: Unknown cause of death

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