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

This is VAERS ID 852775



Case Details

VAERS ID: 852775 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2019-11-15
Onset:2019-11-24
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2019-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS AFLBA422AA / UNK - / OT

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Death, Guillain-Barre syndrome, Hypoaesthesia, Neurological examination
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2019-12-01
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NEO-LOTAN PLUS; ZUGLIMET; IPAMIX
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20191128; Test Name: Neurological examination; Result Unstructured Data: Test Result: unknown, Test Result Unit: unknown
CDC Split Type: ITGLAXOSMITHKLINEIT201922

Write-up: from 24/11/2019 astenia ipostenia hipoesthesia lower limbs with initial progressive initiative arts upper arts. suspect sindrome guillain-barre ''(progressive paralysis).; from 24/11/2019 astenia ipostenia hipoesthesia lower limbs with initial progressive initiative arts upper arts. suspect sindrome guillain-barre ''(progressive paralysis).; from 24/11/2019 astenia ipostenia hipoesthesia lower limbs with initial progressive initiative arts upper arts. suspect sindrome guillain-barre ''(progressive paralysis).; from 24/11/2019 astenia ipostenia hipoesthesia lower limbs with initial progressive initiative arts upper arts. suspect sindrome guillain-barre ''(progressive paralysis).; This case was reported by a physician via regulatory authority and described the occurrence of paralysis ascending in a 81-year-old female patient who received Flu Seasonal QIV Dresden (Fluarix Tetra 2019-2020 season) (batch number AFLBA422AA, expiry date unknown) for prophylaxis. Concomitant products included hydrochlorothiazide + losartan potassium (Neo-Lotan Plus), metformin hydrochloride (Zuglimet) and indapamide (Ipamix). On 15th November 2019, the patient received Fluarix Tetra 2019-2020 season (subcutaneous) 1 dosage form(s). On 24th November 2019, 9 days after receiving Fluarix Tetra 2019-2020 season, the patient experienced paralysis ascending (serious criteria death and GSK medically significant), hyposthenia (serious criteria death), asthenia (serious criteria death) and hypesthesia (serious criteria death). On an unknown date, the outcome of the paralysis ascending, hyposthenia, asthenia and hypesthesia were fatal. The patient died on 1st December 2019. The reported cause of death was hyposthenia, asthenia, paralysis ascending and hypoesthesia. It was unknown if the reporter considered the paralysis ascending, hyposthenia, asthenia and hypesthesia to be related to Fluarix Tetra 2019-2020 season. Additional details; The age at vaccination was not reported however patient could be 80 or 81 years old at the time of vaccination. On 28th November 2019, Neurological examination was done. Initial information was reported by a physician via regulatory authority on 11th December 2019; From 24/11/2019 astenia ipostenia hipoesthesia lower limbs with initial progressive initiative arts upper arts. Suspect sindrome guillain-barre ''(progressive paralysis) Reporter''s comment: Felt the physician on 03/12/2019 for clarifications about the report. The patient has carried out the vaccine on 11/15/2019 for the first time (he had never made it back). The symptoms are verified after 9 days from the vaccination on 11/24/2019: Astenia, ipostenia, hypoesthesia lower limbs with initial progressive development of upper arts. Suspect sindrome guillain-barre ''(progressive paralysis). The patient has been recovered to the hospital. Sender''s comment: Rest pending for delivery by the doctor of the report form with addition of the requested information.; Reported Cause(s) of Death: Hyposthenia; Asthenia; Paralysis ascending; Hypesthesia


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