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This is VAERS ID 846486

Case Details

VAERS ID: 846486 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2019-10-16
Onset:2019-10-23
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2019-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER AFLBA389CA / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2019-10-23
   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: Simvastatin; Pantoprazole; Acetylsalicyl acid; Tamsulosin; ULTIBRO; METOPROLOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Chronic obstructive pulmonary disease; Coronary artery disease; Hydrocephalus (-malresorptivus); Peripheral arterial occlusive disease; Prostatic carcinoma
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEID BIOMEDICAL CORPORATI

Write-up: Unknown cause of death; This case was reported by a physician via regulatory authority and described the occurrence of unknown cause of death in a 83-year-old male 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 copd, peripheral arterial occlusive disease, coronary artery disease, prostatic carcinoma, hydrocephalus (-malresorptivus) and atrial fibrillation. Additional patient notes included Med.-History: Y-prosthesisd. Aorta, C2 Misuse. Concomitant products included simvastatin, pantoprazole, acetylsalicylic acid (Acetylsalicyl Acid), tamsulosin hydrochloride (Tamsulosin), glycopyrronium bromide + indacaterol maleate (Ultibro) and metoprolol. On 16th October 2019, the patient received Influsplit Tetra 2019/2020 (unknown). On 23rd October 2019, 7 days after receiving Influsplit Tetra 2019/2020, the patient experienced unknown cause of death (serious criteria death and GSK medically significant). On an unknown date, the outcome of the unknown cause of death was fatal. The patient died on 23rd 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 the patient could be 83 or 82 years old at time of vaccination. Senders comment: 1.In no case exists on my part the concrete one Suspected one link between Dying and the Flu shot. It happened neither symptoms of a allergic reaction yet feverish infections. 2. According to experience, die significantly more in the fourth quarter Nursing home patients as in the other quarters. In the 4th Quarter of 2018, 8 of 92 cared for by me Hospice patients. 3.The number of 5 deceased Patients (from a total of 82 Home patients) within 2 Weeks after vaccination but extraordinary high. The dying of the Patient was in 4 of the 5 not described expectable. 4. Regarding the prescribed Medication is the only commonality in the as a need for pain prepared Novaminsulfons. Initial information was reported by a physician via regulatory authority on 5th November 2019: Unknown cause of death.; Reported Cause(s) of Death: Unknown cause of death


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