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This is VAERS ID 863176

History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2020

VAERS ID: 863176
VAERS Form:2
Age:62.0
Sex:Female
Location:Unknown
Vaccinated:2020-01-15
Onset:2020-01-15
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, Muscle spasms, Graft versus host disease in gastrointestinal tract

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-09
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: 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.


Changed on 12/10/2020

VAERS ID: 863176 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Unknown Illinois
Vaccinated:2020-01-15
Onset:2020-01-15
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, Muscle spasms, Graft versus host disease in gastrointestinal tract

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-09
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: 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.


Changed on 12/24/2020

VAERS ID: 863176 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Illinois
Vaccinated:2020-01-15
Onset:2020-01-15
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, Muscle spasms, Graft versus host disease in gastrointestinal tract

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-09
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: 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.


Changed on 12/30/2020

VAERS ID: 863176 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Illinois
Vaccinated:2020-01-15
Onset:2020-01-15
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, Muscle spasms, Graft versus host disease in gastrointestinal tract

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-09
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: 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.


Changed on 5/7/2021

VAERS ID: 863176 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Illinois
Vaccinated:2020-01-15
Onset:2020-01-15
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, Muscle spasms, Graft versus host disease in gastrointestinal tract

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-09
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: 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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