National Vaccine
Information Center

Your Health. Your Family. Your Choice.
Search Results

From the 4/13/2011 release of VAERS data (an older release, current is 1/14/2022):

This is VAERS ID 416930

Government Disclaimer on use of this data

Case Details

VAERS ID: 416930 (history)  
Form: Version .0  
Age: 32.0  
Sex: Male  
Location: Delaware  
   Days after vaccination:23
Submitted: 2011-02-16
   Days after onset:83
Entered: 2011-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: Private
Symptoms: Anion gap increased, Blood calcium decreased, Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Blood phosphorus decreased, Carbon dioxide decreased, Cardiac arrest, Cardioversion, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Convulsion, Death, Depressed level of consciousness, Dyspepsia, Echocardiogram abnormal, Electrocardiogram abnormal, Electroencephalogram abnormal, Heart sounds abnormal, Hypoxic-ischaemic encephalopathy, Intensive care, Left ventricular failure, Loss of consciousness, Multi-organ failure, Nuclear magnetic resonance imaging brain abnormal, Posturing, Renal failure acute, Troponin T increased, Unresponsive to stimuli, Ventilation/perfusion scan abnormal, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (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), Convulsions (narrow), Dystonia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-12-04
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: seizure resulting in defribrilation resulting in anoxic brain injury. treated at Hospital.

New Search

Link To This Search Result:

Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166