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This is VAERS ID 903560

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 903560
VAERS Form:2
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2020-12-01
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER UNK / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-01
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: Autoimmune disorder (compromised immune system)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USGLAXOSMITHKLINEUS2020AM

Write-up: died / deathly ill; This case was reported by a consumer via interactive digital media and described the occurrence of unknown cause of death in a 58-year-old male patient who received Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent unspecified season) for prophylaxis. Concurrent medical conditions included autoimmune disorder (compromised immune system). On an unknown date, the patient received Influenza vaccine Quadrivalent unspecified season. In December 2020, unknown after receiving Influenza vaccine Quadrivalent unspecified season, the patient experienced death (serious criteria death and GSK medically significant). On an unknown date, the outcome of the death was fatal. The patient died in December 2020. The reported cause of death was unknown cause of death. It was unknown if the reporter considered the death to be related to Influenza vaccine Quadrivalent unspecified season. Additional details were received as follows: The age at vaccination was not reported. The patient died in December of 2019. He got deathly ill right after he got a flu shot. He had a compromised immune system so the reporter wanted to know why did they give him the shot.; Reported Cause(s) of Death: Unknown cause of death


Changed on 12/30/2020

VAERS ID: 903560 Before After
VAERS Form:2
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2020-12-01
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER UNK / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-01
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: Autoimmune disorder (compromised immune system)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USGLAXOSMITHKLINEUS2020AM

Write-up: died / deathly ill; This case was reported by a consumer via interactive digital media and described the occurrence of unknown cause of death in a 58-year-old male patient who received Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent unspecified season) for prophylaxis. Concurrent medical conditions included autoimmune disorder (compromised immune system). On an unknown date, the patient received Influenza vaccine Quadrivalent unspecified season. In December 2020, unknown after receiving Influenza vaccine Quadrivalent unspecified season, the patient experienced death (serious criteria death and GSK medically significant). On an unknown date, the outcome of the death was fatal. The patient died in December 2020. The reported cause of death was unknown cause of death. It was unknown if the reporter considered the death to be related to Influenza vaccine Quadrivalent unspecified season. Additional details were received as follows: The age at vaccination was not reported. The patient died in December of 2019. He got deathly ill right after he got a flu shot. He had a compromised immune system so the reporter wanted to know why did they give him the shot.; Reported Cause(s) of Death: Unknown cause of death


Changed on 5/7/2021

VAERS ID: 903560 Before After
VAERS Form:2
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2020-12-01
Submitted:0000-00-00
Entered:2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER UNK / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-01
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: Autoimmune disorder (compromised immune system)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USGLAXOSMITHKLINEUS2020AM

Write-up: died / deathly ill; This case was reported by a consumer via interactive digital media and described the occurrence of unknown cause of death in a 58-year-old male patient who received Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent unspecified season) for prophylaxis. Concurrent medical conditions included autoimmune disorder (compromised immune system). On an unknown date, the patient received Influenza vaccine Quadrivalent unspecified season. In December 2020, unknown after receiving Influenza vaccine Quadrivalent unspecified season, the patient experienced death (serious criteria death and GSK medically significant). On an unknown date, the outcome of the death was fatal. The patient died in December 2020. The reported cause of death was unknown cause of death. It was unknown if the reporter considered the death to be related to Influenza vaccine Quadrivalent unspecified season. Additional details were received as follows: The age at vaccination was not reported. The patient died in December of 2019. He got deathly ill right after he got a flu shot. He had a compromised immune system so the reporter wanted to know why did they give him the shot.; Reported Cause(s) of Death: Unknown cause of death

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