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From the 9/14/2017 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 27000



Case Details

VAERS ID: 27000 (history)  
Form: Version 1.0  
Age: 28.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:1989-08-15
Onset:1989-08-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 241916 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Cardiac arrest, Dyspnoea, Neuropathy, Paraesthesia, Pneumonia, Pneumothorax, Urinary tract infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy report dx: acute inflammatory polyneuropathy, interstitial pneumonitis, urinary tract infection, pneumothorax, cytomegalovirus infection, Epstein-Barr virus infection & cardiorespiratory arrest.
CDC Split Type: 890189201

Write-up: Pt vaccinated with TD c/o numbness of hand & feet 24-48 hrs after vaccination, decreased sensation in both feet (to pinprick), developed polyneuropathy & required mechanical ventilation, developed respiratory distress, suffered CR arrest.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=27000

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