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From the 4/30/2021 release of VAERS data:

This is VAERS ID 863176



Case Details

VAERS ID: 863176 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Illinois  
Vaccinated:2020-01-15
Onset:2020-01-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Biopsy, Death, Diarrhoea, Graft versus host disease in gastrointestinal tract, Muscle spasms
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-02-09
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient also had developed odd myalgias shortly after transplant that improved with steroids.
Allergies:
Diagnostic Lab Data: Upper GI Endoscopic Biopsy, 22-Jan-2020, Severe acute GVHD
CDC Split Type:

Write-up: Patient received the Fluarix Quadrivalent vaccination on 01/15/2020, approximately 6 months after his stem cell transplant. The next day he developed diarrhea that progressed over the weekend with abdominal pain and cramping requiring hospital admission. Upon admission he was found to have acute graft-versus-host disease (GVHD) of the GI tract, potentially incited by the immune activation from his influenza vaccination. Unfortunately the patient''s GVHD was refractory to multiple lines of therapy and led to his death less than a month after presentation.


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