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This is VAERS ID 849895

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2020

VAERS ID: 849895
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2019-11-04
Onset:2019-11-01
Submitted:0000-00-00
Entered:2019-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (QIV DRESDEN) / GLAXOSMITHKLINE BIOLOGICALS AFLBA411AE / UNK LA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEGLAXOSMITHKLINEDE201921

Write-up: The patient was found dead in the apartment the day after the vaccination; This case was reported by a physician via regulatory authority and described the occurrence of found dead in a 45-year-old male patient who received Flu Seasonal QIV Dresden (Influsplit Tetra 2019/2020) (batch number AFLBA411AE, expiry date unknown) for prophylaxis. On 4th November 2019, the patient received Influsplit Tetra 2019/2020 (intramuscular). In November 2019, 1 day after receiving Influsplit Tetra 2019/2020, the patient experienced found dead (serious criteria death and GSK medically significant). On an unknown date, the outcome of the found dead was fatal. The reported cause of death was unknown cause of death. An autopsy was performed. It was unknown if the reporter considered the found dead to be related to Influsplit Tetra 2019/2020. Additional information: The age at vaccination was not reported however patient could be 44 or 45 years old at the time of vaccination. The agency assessment was reported as D. Unclassifiable. The anatomical location of vaccine was reported as left upper arm. Initial information was received from a Physician via regulatory authority on 22nd November 2019: The patient was found dead in the apartment the day after the vaccination. Sender''s comments: Since October multiple vaccinations. On 04.11 more vaccinations with the same batch number.; Reported Cause(s) of Death: Unknown cause of death


Changed on 12/24/2020

VAERS ID: 849895 Before After
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2019-11-04
Onset:2019-11-01
Submitted:0000-00-00
Entered:2019-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (QIV DRESDEN) / GLAXOSMITHKLINE BIOLOGICALS AFLBA411AE / UNK LA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEGLAXOSMITHKLINEDE201921

Write-up: The patient was found dead in the apartment the day after the vaccination; This case was reported by a physician via regulatory authority and described the occurrence of found dead in a 45-year-old male patient who received Flu Seasonal QIV Dresden (Influsplit Tetra 2019/2020) (batch number AFLBA411AE, expiry date unknown) for prophylaxis. On 4th November 2019, the patient received Influsplit Tetra 2019/2020 (intramuscular). In November 2019, 1 day after receiving Influsplit Tetra 2019/2020, the patient experienced found dead (serious criteria death and GSK medically significant). On an unknown date, the outcome of the found dead was fatal. The reported cause of death was unknown cause of death. An autopsy was performed. It was unknown if the reporter considered the found dead to be related to Influsplit Tetra 2019/2020. Additional information: The age at vaccination was not reported however patient could be 44 or 45 years old at the time of vaccination. The agency assessment was reported as D. Unclassifiable. The anatomical location of vaccine was reported as left upper arm. Initial information was received from a Physician via regulatory authority on 22nd November 2019: The patient was found dead in the apartment the day after the vaccination. Sender''s comments: Since October multiple vaccinations. On 04.11 more vaccinations with the same batch number.; Reported Cause(s) of Death: Unknown cause of death


Changed on 12/30/2020

VAERS ID: 849895 Before After
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2019-11-04
Onset:2019-11-01
Submitted:0000-00-00
Entered:2019-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (QIV DRESDEN) / GLAXOSMITHKLINE BIOLOGICALS AFLBA411AE / UNK LA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEGLAXOSMITHKLINEDE201921

Write-up: The patient was found dead in the apartment the day after the vaccination; This case was reported by a physician via regulatory authority and described the occurrence of found dead in a 45-year-old male patient who received Flu Seasonal QIV Dresden (Influsplit Tetra 2019/2020) (batch number AFLBA411AE, expiry date unknown) for prophylaxis. On 4th November 2019, the patient received Influsplit Tetra 2019/2020 (intramuscular). In November 2019, 1 day after receiving Influsplit Tetra 2019/2020, the patient experienced found dead (serious criteria death and GSK medically significant). On an unknown date, the outcome of the found dead was fatal. The reported cause of death was unknown cause of death. An autopsy was performed. It was unknown if the reporter considered the found dead to be related to Influsplit Tetra 2019/2020. Additional information: The age at vaccination was not reported however patient could be 44 or 45 years old at the time of vaccination. The agency assessment was reported as D. Unclassifiable. The anatomical location of vaccine was reported as left upper arm. Initial information was received from a Physician via regulatory authority on 22nd November 2019: The patient was found dead in the apartment the day after the vaccination. Sender''s comments: Since October multiple vaccinations. On 04.11 more vaccinations with the same batch number.; Reported Cause(s) of Death: Unknown cause of death


Changed on 5/7/2021

VAERS ID: 849895 Before After
VAERS Form:2
Age:
Sex:Male
Location:Foreign
Vaccinated:2019-11-04
Onset:2019-11-01
Submitted:0000-00-00
Entered:2019-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (QIV DRESDEN) / GLAXOSMITHKLINE BIOLOGICALS AFLBA411AE / UNK LA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEGLAXOSMITHKLINEDE201921

Write-up: The patient was found dead in the apartment the day after the vaccination; This case was reported by a physician via regulatory authority and described the occurrence of found dead in a 45-year-old male patient who received Flu Seasonal QIV Dresden (Influsplit Tetra 2019/2020) (batch number AFLBA411AE, expiry date unknown) for prophylaxis. On 4th November 2019, the patient received Influsplit Tetra 2019/2020 (intramuscular). In November 2019, 1 day after receiving Influsplit Tetra 2019/2020, the patient experienced found dead (serious criteria death and GSK medically significant). On an unknown date, the outcome of the found dead was fatal. The reported cause of death was unknown cause of death. An autopsy was performed. It was unknown if the reporter considered the found dead to be related to Influsplit Tetra 2019/2020. Additional information: The age at vaccination was not reported however patient could be 44 or 45 years old at the time of vaccination. The agency assessment was reported as D. Unclassifiable. The anatomical location of vaccine was reported as left upper arm. Initial information was received from a Physician via regulatory authority on 22nd November 2019: The patient was found dead in the apartment the day after the vaccination. Sender''s comments: Since October multiple vaccinations. On 04.11 more vaccinations with the same batch number.; Reported Cause(s) of Death: Unknown cause of death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=849895&WAYBACKHISTORY=ON


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