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Found 143 cases where Vaccine is FLU(H1N1) or FLUN(H1N1) or FLUX(H1N1) and Patient Died and Submission Date on/before '2015-09-30'

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Table

   
AgeVaccine CountCountPercent
< 3 Years1117.69%
221.4%
310.7%
432.1%
total1711.89%
3-6 Years110.7%
410.7%
total21.4%
6-9 Years153.5%
total53.5%
9-12 Years210.7%
total10.7%
12-17 Years110.7%
210.7%
total21.4%
17-44 Years12215.38%
253.5%
321.4%
total2920.28%
44-65 Years12819.58%
285.59%
321.4%
total3826.57%
65-75 Years196.29%
242.8%
total139.09%
75+ Years1117.69%
221.4%
total139.09%
Unknown11611.19%
274.9%
total2316.08%
TOTAL143100%

Case Details

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VAERS ID:361353 (history)  Vaccinated:2009-10-08
Age:9.0  Onset:2009-10-14, Days after vaccination: 6
Gender:Female  Submitted:2009-10-16, Days after onset: 2
Location:California  Entered:2009-10-16
Life Threatening? No
Died? Yes
   Date died: 2009-10-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Limping
Preexisting Conditions: H/O Leukemia 2002; Down''s Syndrome. 1022/09 PCP /Nursing medical records received, service dates 11/11/03 to 10/14/09. Down Syndrome. Cough, fever. Frequent colds. Discharge from eyes. Vomiting and diarrhea. Lymphadenopathy. Foot pain. CBC abnormal.
Diagnostic Lab Data: CBC: 2.5, 7.5, 21.3, 207; Sed rate 125. 10/20/09 ER records received service date 10/14/09. LABS and Diagnostics: EEG - Asystole. CHEM - Glucose 107 mg/dL (H) Calcium 3.5 mg/dL (L) Albumin 3.4 g/dL (L) Alk Phos 170 U/L (L). CBC - WBC 2.5 Thou/uL (L) RBC 2.57 Mill/uL (L) HGB 7.5 g/dL (L) HCT 27.3% (L) RDW 16.4% (H) Neut ABS 565 cells/uL (L) Mono ABS 33 cells/uL (L) Eosin 3 cells/uL (L)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3203AA2IMLA
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE))MEDIMMUNE VACCINES, INC.500751P0IN 
Administered by: Private     Purchased by: Unknown
Symptoms: Blood alkaline phosphatase normal, Blood glucose normal, Death, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Immunohistochemistry, Neisseria test positive, Pupil fixed, Red blood cell sedimentation rate increased
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad)
Write-up: None Stated. On 10/19/09, the PCP stated that coroner called him and told him that he found consolidation of the lungs on autopsy. Autopsy report is not complete yet. 10/20/09 ER records received service date 10/14/09. Assessment: Cardiac arrest. CPR initiated. Pupils fixed and dilated. Apnea, pale. Rigor, lividity. 1022/09 PCP /Nursing medical records received, service dates 11/11/03 to 10/14/09. Assessment: Death. Office staff unable to contact patient''s family, eventually visited patient''s home. learnd that patient was found dead at home and taken to ER. 11/3/09 Additional ER records received for service date 10/14/09. Found supine on floor at home apneic and pulseless. Cardiac arrest. CPR initiated. 12/8/09 Autopsy received. Pronounced dead on 10/13/2009 Final cause of death: Pneumococcal Pneumonia. Pandemic Influenza A. Additional Information Abstracted: Other contributing conditions - Leukopenia, history of leukemia, Down syndrome. Drug Screen Heart Blood: Dextromethorphan <0.10 ug/ml, Promethazine 0.11 ug/ml. /ksk 12/28/09 Pathology report received. Receipt date 10/23/2009. Sign out date 12/21/2009. Diagnosis: Lung - Diffuse alveolar damage and bronchopneumonia. Immunohistochemical and molecular evidence of novel influenza A H1N1. Immunohistochemical and molecular evidence of Streptococcus pneumoniae. Immunohistochemical evidence of Neisseria meningitidis without molecular confirmation. No immunohistochemical evidence of Group A Streptococcus or Haemophilus influenzae. All follow-up attempts have been completed per company SOPs. No further information available.

VAERS ID:362855 (history)  Vaccinated:2009-10-22
Age:35.0  Onset:2009-10-25, Days after vaccination: 3
Gender:Female  Submitted:2009-10-26, Days after onset: 1
Location:Oregon  Entered:2009-10-26
Life Threatening? No
Died? Yes
   Date died: 2009-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: none known
Current Illness: spherocytosis, hemolitic onemica
Preexisting Conditions: none. /27/09 ER and hospital records received service date 10/25/09. Splenectomy. Appendectomy. 11/02/09: Primary Care Records received for date of service 10/9/09. PMH: Heriditary spherocytosis with splenectomy, D&C, L ACL Repair, L arthroscopic knee surgery.
Diagnostic Lab Data: /27/09 ER and hospital records received service date 10/25/09. LABS and DIAGNOSTICS: ECG - Abnormal, sinus tachycardia, Nonspecific ST and T wave abnormality. Arterial Blood gases: pCO2 50 mmHg (H) O2 Sat 83% (L) Bicarb 8.0 mmol/L (L) Base Excess -26.0 mEq/L (L) pH 6.8 (L). CHEM - Potassium 3.0 mmol/L (L) Glucose 27 mg/dL (L) Creatinine 2.42 mg/dL (H) AST 121 IU/L (H) Bilirubin Total 1.6 mg/dL (H). GFR 28 mL/min/1.73 m2 (L). CBC - RDW 15.0% (H) PLT 91 10^9/L (L) Neutrophils 20.0% (L) Bands 20% (H) Metamyelocytes 3% (H) Lymph 55.0% (H) Lymphs Atyp 1% (H) Anisocytosis slight, Howell Jolly Body few, Vacuolated Polys moderate. Blood culture (+) for Streptococcus pneumoniae. Chest X-ray - Abnormal. 10/29/09 Hospital lab report. Blood Culture Fi
CDC Split Type:
Vaccination
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Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE))MEDIMMUNE VACCINES, INC.500765P0IN 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Death, Dyspnoea, Influenza like illness
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Patient got sick with flu like symptoms on 10/24 around 1PM, went to hospital with trouble breathing around 9PM, was pronounced deceased at 1AM on 10/25. 10/27/09 ER and hospital records received service date 10/25/09. Assessment: Death due to septic shock secondary to infection of unknown source. Asplenia. Patient had nausea, vomiting, chills, stomach cramping, diarrhea, tachypnea, hypotension, diaphoresis for one day. Limited oral intake. Became cyanotic around lips, fingernails, and toenails. Presented to ER hypotensive, hypoxic, no longer breathing. Tachycardia. Cardiac arrest presenting as pulseless electrical activity (PEA). Hyperacidemia. Resusitation. Intubated and transported to ICU. Bilateral infiltrates consistent with acute respiratory distress syndrome. End-organ damage including kidneys and brain. Repeated PEA. No pulse. Mottling of head and extremities. Overwhelming sepsis and septic shock. Patient expired. 11/02/09: Primary Care Records received for date of service 10/9/09. Seasonal flu vaccine record received VAERS updated. Assessment: Presented with vaginal bleeding x 3 weeks, had hx. of D&C in 08 2/2 heavy vaginal bleeding. Also presented with a cold that started 5 days prior, afebrile at visit. Seasonal Flu vaccine given. 11/05/09 Diagnostic/lab results received. IDPB Test results: Lung section shows increased interstitial inflammatory infiltrates. Heart section shows focal interstitial edema and extravasation. No evidence of myocarditis. Liver section shows increased portal infiltrates and dilated sinusoids with Kupffer cell hyperplasia. Special stains: Scattered gram-positive cocci in lung, heart and liver. Immunohistochemical Assays: (+) Strep penumoniae in lung, heart and liver. (-) for influenza virus. PCR Assays: Negative for 2009 pandemic H1N1 influenza A virus. PCR for penumoniae pending. 12/14/09 Autopsy Records receivedI. DOD 10/25/09. Final Cause of Death: Streptococcus Pneumonia Sepsis. II. Hemolytic Anemia with Splenectomy. Additional information abstracted: Arteriovenous malformation of brain. Cholecystectomy remote. Blood cultures (+) for streptococcus pneumonias.

VAERS ID:363458 (history)  Vaccinated:2009-10-26
Age:46.0  Onset:2009-10-27, Days after vaccination: 1
Gender:Female  Submitted:2009-10-28, Days after onset: 1
Location:Florida  Entered:2009-10-28
Life Threatening? No
Died? Yes
   Date died: 2009-10-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI))SANOFI PASTEURUP004AA0IMUN
Administered by: Other     Purchased by: Unknown
Symptoms: Death, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.

VAERS ID:365165 (history)  Vaccinated:2009-10-30
Age:49.0  Onset:2009-11-02, Days after vaccination: 3
Gender:Female  Submitted:2009-11-04, Days after onset: 2
Location:Tennessee  Entered:2009-11-04
Life Threatening? No
Died? Yes
   Date died: 2009-11-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Identified
Preexisting Conditions: aspirin Steriods Augmentin.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI))SANOFI PASTEURUP009AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0509Y IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Death
SMQs:
Write-up: UNKNOWN.

VAERS ID:365381 (history)  Vaccinated:2009-11-03
Age:77.0  Onset:2009-11-05, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:Virginia  Entered:2009-11-05
Life Threatening? No
Died? Yes
   Date died: 2009-11-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: COUMADIN; GLYPIZIDE; LIPITOR; AVODART
Current Illness: None
Preexisting Conditions: NKDA; Afib; Lung CA. PMH: Small cell Lung CA, lobectomy x2 2006, 4 month hospitalization, aspiration, tracheostomy, failure to thrive, PEG tube. Hypertension, inguinal hernia, GERD, hyperlipidemia, diabetes, secondary heart block, Wenckebach, chronic constipation, urinary retention (Foley 2005), DVT R leg recurrent, atrial fib, past smoker, family h/o heart disease and CA.
Diagnostic Lab Data: PT/INR, 2.1.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI))SANOFI PASTEURUU013AA0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Death, International normalised ratio, Myocardial infarction, Prothrombin time
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)
Write-up: 77 y/o with Afib and lung cancer given H1N1 (Sanofi) on 11/3/09- Died. 11/5/09-prob. heart attack. 11/06/09 Medical records received. DOS 08/21/08-03/24/09. PCP office notes. Visits note looked well, unremarkable PEs with well healed surgical scars, clear bronchial to minimal wheeze, CBCs WNL w/some low 02 sats (92% on R/A). Extrems trace PTE, until 03/24/09. DX bad cold w/ white mucus and cough. Nausea, low grade fever. Lung sounds benign. Mild leukocytosis, possible infection. Tx Levaquin. 4/28/09 Congestion continued, thick mucus, worse since pneumonia. Bronchial w/minimal wheezes. CBC WNL. EKG sinus rhythm, systolic murmur. Subsequent visits showed 02 sat 91%, weight loss. 11/03 occasional SOB, H1N1 vaccine given. Labs & Diags EKG- normal, sinus mechanism, bradycardia 48. 12/17/09 Death Certificate received. DOD 11/05/09. Cause of Death. Myocardial infarction. Other information abstracted: Other medical conditions - lung cancer, atrial fibrillation.

VAERS ID:365786 (history)  Vaccinated:2009-11-05
Age:1.41  Onset:2009-11-06, Days after vaccination: 1
Gender:Male  Submitted:2009-11-06, Days after onset: 0
Location:California  Entered:2009-11-06
Life Threatening? No
Died? Yes
   Date died: 2009-11-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Seizures PMH: hx of seizure 7/2009. Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI))SANOFI PASTEURUT014AA0UNUN
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)SANOFI PASTEURUT3178CA0UNUN
PNC: PNEUMO (PREVNAR)PFIZER/WYETHD500030UNUN
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0681Y0UNUN
Administered by: Private     Purchased by: Private
Symptoms: Adenoidal disorder, Blood bicarbonate decreased, Blood culture, Blood pH decreased, Blood urea increased, Brain oedema, C-reactive protein increased, CSF protein decreased, Chest X-ray, Computerised tomogram abnormal, Condition aggravated, Conduction disorder, Convulsion, Death, Electrocardiogram abnormal, Electroencephalogram, Full blood count, Gliosis, Influenza serology negative, PCO2 increased, Pneumonia aspiration, Polymerase chain reaction, Postictal state, Respiratory failure, Sinus tachycardia, Urine analysis normal
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Lactic acidosis (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Convulsions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Patient Died.

VAERS ID:366608 (history)  Vaccinated:2009-11-06
Age:53.0  Onset:2009-11-07, Days after vaccination: 1
Gender:Female  Submitted:2009-11-11, Days after onset: 4
Location:Tennessee  Entered:2009-11-11
Life Threatening? No
Died? Yes
   Date died: 2009-11-11
   Days after onset: 4
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: patient was in car accident on 10/07/2009
Current Illness: Friday c/o bronchitis symptoms and recieved Zpac
Preexisting Conditions: allergy to Phenergan and Elavil. ESRD. Hx of a-fib. 11/13/09: Dialysis Notes received for date of service 11/4/09: Dx: Renal failure 2/2 HTN. secondary hypothyroidism (of renal origin), unspecified chest pain, unspecified deficiency anemia, unspecified peritonitis, hyperparathyroidism, phosphorous disorder, atrial fibrillation, hyperkalemia, nasopharyngitis, depression. 11/13/09: Discharge Summary received from dates of service 10/07/09 to 10/11/09. DX: Lacerated spleen, fractures of cervical 5 and 6. Assessment: Involved in an MVA on 10/7/09 in which she suffered a lacerated spleen and fractures of cervical 5 and 6. Discharged to home on 10/11/09. PMH: Anemia in Chronic Renal Disease, Chronic Renal Failure, ESRD due to HTN,
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS))NOVARTIS VACCINES AND DIAGNOSTICS1009231IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Death, Hypotension, Malaise, Nausea, Weight increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: General malaise, nausea, hypotension. 11/13/09: Medical record for date of correspondence 11/13/09: Assessment: Received H1N1 vaccine 11/6/09 at a dialysis appointment and did not feel well, c/o nausea and malaise on 11/7 & 11/8/09, according to pt''s husband, she continued to feel unwell on 11/10/09. On the morning of 11/11/09 the patient was found to have died in her sleep. 11/13/09: Hospital discharge summary(hospitalizaton prior to vaccine), hemodialysis clinic records and correspondence of case summary received. On 11/09/09, patient received out-patient dialysis. The patient had gained four pounds since her previous dialysis appointment. 12/21/09 Death Certificate received. DOD 11/11/09. Cause of Death: Hypertensive cardiovascular disease.

VAERS ID:366976 (history)  Vaccinated:2009-10-28
Age:61.0  Onset:2009-10-29, Days after vaccination: 1
Gender:Male  Submitted:2009-11-12, Days after onset: 14
Location:New Jersey  Entered:2009-11-12
Life Threatening? No
Died? Yes
   Date died: 2009-11-10
   Days after onset: 12
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: AMBIEN; amiodarone; Bayer Aspirin; clonidine HCl; COLACE; DULCOLAX; FERRLECIT; FLOMAX; heparin sodium (porcine); hydroxyzine HCl; LEVOXYL; NEPHROCAPS; normal saline; oxygen; PEPCID; PERCOCET; PhosLo; PROAMATINE; TRILEPTAL; TYLENOL; ZEMPLAR;
Current Illness:
Preexisting Conditions: Allergies: Nitrous oxide; Novacaine; PMH: see below *. PMH: Severe peripheral vascular disease. Amputation of left leg. hypertension, hypertensive cardiovascular disease, diabetes mellitus, cerebrovascular accident in the past, End-stage renal disease on hemodialysis, coronary artery disease, chronic obstructive coronary disease, seizure disorder.
Diagnostic Lab Data: obtained at our medical center. LABS and DIAGNOSTICS: Chest X-ray - Abnormal, nodule left lung. CBC - RBC 3.21 Mill/uL (L) HGB 11.2 g/dL (L) HCT 32.2% (L) MCV 102.0 fL (H) MCH 35.0 pg (H) RDW 21.2% (H) Platelets 67 Thou/uL (L). CHEM - Chloride 96 mmol/L (L) CO2 33 mmol/L (H) Creatinine 3.6 mg/dL (H) BUN CREAT Ratio 9.3 (L) Glucose 138 mg/dL (H) eGFR 17 mL/min (L).
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI))SANOFI PASTEURUP013AA IMLA
Administered by: Other     Purchased by: Public
Symptoms: Death, Dyspnoea, Feeling cold, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Pre dialysis on 10/30/09 complained of achiness (generalized), feeling cold, difficulty breathing. Lungs were clear (oxygen administered w/ ease of breathing), BP 129/41, HR 81 - regular temp 98.38. TYLENOL given for pain #7/10 on pain scale. Patient 3.4 kg $g EDW. Edema +2 pitting in right leg. Reported patient condition to Nephrologist. Hemodialysis treatment initiated and completed without complication. Patient refused to be evaluated at ER and discharged home in stable condition. 11/13/09 Medical records received. Dialysis records for DOS 10/28-10/30. C/o fainting x3 at home. Can''t stay awake. Vaccine given same day (10/28). Admits he had called 911 x2 looking for help that day. Seen 2 days later and c/o coldness, hurting all over. Can''t breath. Kept asking for help. Staff offered to call 911. Refused. Afebrile. No flu like sx noted by staff other than achy. Dialysis tx given. D/C to home. Follow-up call made. Pt OK. Went to bed. 11/16/09 Two discharge summaries received, hospital records. Service dates 10/30/09 to 11/10/09. Assessment: Dehydration, swine flu reaction, Patient presented with fevers, generalized aches, and pains. Very weak and sick. Headache. Non-healing ulcer on right heel. While in hospital became lethargic and difficult to arouse. Developed high fever (105.5), more confused and lethargic. Bradycardic, patient intubated, lost peripheral pulses, resusitation not sucessful, pronounced deceased. 0/04/2010 Death Certificate received. DOD 11/10/2009. Cause of Death: Coronary artery disease, severe peripheral vascular disease, chronic obstructive pulmonary disease, septicemia. Other significant conditions: Status post left below knee amputation, depression, diabetes.

VAERS ID:367270 (history)  Vaccinated:2009-11-05
Age:2.0  Onset:2009-11-05, Days after vaccination: 0
Gender:Female  Submitted:2009-11-13, Days after onset: 8
Location:North Carolina  Entered:2009-11-13
Life Threatening? No
Died? Yes
   Date died: 2009-11-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known except those noted in 19
Preexisting Conditions: Status encephalopathy; control apnea; seizure disorder; GERD; S/P Nissen EG-Tube; traumatic brain damage; NKA. 11/17/09 PCP medical records and ED records received service date 11/5/09. Traumatic brain damage, feeding tube in abdomen. Heart murmur. 11/20/09 Extensive PCP, ED, Hospital, rehabilitation, and consultation records received documenting a complex past medical history. Service dates 6/1/07 to 11/5/09. Profound developmental delay and neurologic compromise. Seizures. Cortical visual impairment. Pneumonia, hydropneumothorax, nonaccidental trauma s/p left subdural hematoma, right occipital skull fracture, cystic encephalomalacia, gastroesophageal reflux disease, central apnea, gastroscopy tube placement, Nissen fundoplication.
Diagnostic Lab Data: Autopsy report pending. 11/17/09 PCP medical records and ED records received service date 11/5/09. LABS and DIAGNOSTICS: ECG - Abnormal.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI))SANOFI PASTEURUT014FA0IMRL
Administered by: Private     Purchased by: Public
Symptoms: Autopsy, Blood pressure immeasurable, Cardiac arrest, Cardio-respiratory arrest, Cardioversion, Cerebral atrophy, Condition aggravated, Cyanosis, Death, Electrocardiogram abnormal, Endotracheal intubation, Mydriasis, Organising pneumonia, Peripheral coldness, Pneumonia, Pulse absent, Pupil fixed, Respiratory arrest, Resuscitation, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Arrived to ED at 1214 via EMS. In asystole and CPR in progress. Intubated and defibrillated in field. Interosseous IV started in ED. Epinephrine, bicarb, and glucose administered. Code stopped at 1236. 11/17/09 PCP medical records and ED records received service date 11/5/09. Assessment: Cardiopulmonary arrest. Child presented for H1N1 vaccination with nasal congestion and oxygen via nasal cannula. No mention from mother of concerns, no noticeable distress from child. Later at home grandmother heard O2 Oximeter beep, found child unresponsive and not breathing. Mother performed CPR. EMS started ACLS, intubated, and defibrillated. Interosseous IV. Pupils on admission Fixed and dilated. No spontaneous respirations. No cardiac activity - asystole. No pulse. No blood pressure. Skin cyanotic and cool. Code terminated. Deceased.

VAERS ID:367379 (history)  Vaccinated:2009-10-28
Age:56.0  Onset:2009-10-28, Days after vaccination: 0
Gender:Female  Submitted:2009-11-14, Days after onset: 17
Location:Alabama  Entered:2009-11-14
Life Threatening? No
Died? Yes
   Date died: 2009-10-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none known
Preexisting Conditions: none known
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI))SANOFI PASTEURUP003AA IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Amputation, Death, Injury, Road traffic accident
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad)
Write-up: Killed in a car accident while pulling out of the street where the clinic was located. Was turning left onto a divided highway when the driver''s side door was hit by an oncoming vehicle. Died on impact.

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