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

This is VAERS ID 972898



Case Details

VAERS ID: 972898 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Ohio  
Vaccinated:2019-09-30
Onset:2019-10-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ249AA / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Encephalopathy, Haemophagocytic lymphohistiocytosis, Laboratory test, Malaise, Septic shock
SMQs:, Toxic-septic shock conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2019-10-09
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: pred forte right eye, zaditor right eye, finasteride 5 mg daily, aspirin 81 mg daily, MVI, xyzal 5 mg daily, saw palmetto, antivert 25 mg TID PRN, pantoprazole 40 mg daily, lisinopril 20 mg daily, verapamil 180 mg daily, atorvastatin 20 mg
Current Illness:
Preexisting Conditions: HTN, high cholesterol, BPH, meniere''s
Allergies: NKDA
Diagnostic Lab Data: Many tests performed during hospitalization 10/06/2019 through 10/09/2019
CDC Split Type:

Write-up: 5 days after receiving the vaccination the patient developed generalized malaise progressing to encephalopathy. He was admitted to the hospital with presumed septic shock, and work-up revealed hemophagocytic lymphohistiocytosis. He died from the disease process 9 days after vaccination.


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