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

This is VAERS ID 896168



Case Details

VAERS ID: 896168 (history)  
Form: Version 2.0  
Age: 2.0  
Sex: Female  
Location: Arizona  
Vaccinated:2020-10-05
Onset:2020-10-11
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2020-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7035LA / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Constipation, Death, Faecal volume increased, Gastric dilatation, Intra-abdominal fluid collection, Ultrasound abdomen abnormal, Urinary system X-ray, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific dysfunction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nasal saline drops, multivitamin
Current Illness:
Preexisting Conditions: systolic heart murmur
Allergies: no known allergies
Diagnostic Lab Data: 10/11/20 KUB x-ray and abdominal ultrasound. Markedly enlarged fluid distended stomach. This limits evaluation for direct findings of volvulus. Markedly distended presumed stomach in the abdomen. Moderate to large colonic stool volume suggesting constipation. Numerous punctate calcific densities in the left lateral abdomen likely related to stool contents.
CDC Split Type:

Write-up: Pt was seen in ED with abdominal pain, distention, and vomiting. Was flown to another Hospital. Unknown until notification of death. No other information known.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=896168


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