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This is VAERS ID 972898

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 972898
VAERS Form:2
Age:68.0
Sex:Male
Location:Ohio
Vaccinated:2019-09-30
Onset:2019-10-05
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, Malaise, Septic shock, Laboratory test, Haemophagocytic lymphohistiocytosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-10-09
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? Yes, days: 3     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.


Changed on 5/7/2021

VAERS ID: 972898 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Ohio
Vaccinated:2019-09-30
Onset:2019-10-05
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, Malaise, Septic shock, Laboratory test, Haemophagocytic lymphohistiocytosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-10-09
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? Yes, days: 3     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 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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