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From the 12/31/2008 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 311987

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Case Details

VAERS ID: 311987 (history)  
Form: Version .0  
Age: 57.0  
Sex: Male  
Location: Minnesota  
   Days after vaccination:33
Submitted: 2008-05-09
   Days after onset:172
Entered: 2008-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Acute respiratory failure, Antinuclear antibody negative, Biopsy brain abnormal, Blindness, Brain oedema
SMQs:, Anaphylactic reaction (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), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-01-21
   Days after onset: 64
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none PMH: cranial atherosclerosis, distant history of melanoma excised 15 yrs ago; erectile dysfunction; DJD. Bell''s palsy s/p swine flu shot, resolved. Tennis elbow/bursitis, resolved. Dysuria. Diabetes.
Diagnostic Lab Data: unknown LABS: MRI of orbits revealed bilateral optic nerve enhancement (prechiasmal). Sed rate, CRP, ANA & CBC WNL.
CDC Split Type:

Write-up: information is a verbal report from spouse, onset of illness 32 days after vaccination, treated by primary care MD, thought he had a virus, became blind by 11/21/07, continued deterioration to death. Autospy preformed: found patient had a demylinating pro"cess as cause of death. 05/27/08 Autopsy report reviewed which states COD as presumed acute pneumonia (autopsy limited to examination of brain). Report also states clinical hx of acute respiratory failure, febrile illness & staph aureus & e.coli dx on b

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