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

This is VAERS ID 417551

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Case Details

VAERS ID: 417551 (history)  
Form: Version .0  
Age: 89.0  
Sex: Female  
Location: California  
   Days after vaccination:2
Submitted: 2011-02-24
   Days after onset:5
Entered: 2011-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Unknown
Symptoms: Acute respiratory failure, Alanine aminotransferase increased, Anaemia, Aspartate aminotransferase increased, Asthenia, Atrial fibrillation, Back pain, Blood alkaline phosphatase increased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood culture negative, Blood potassium increased, Blood urea increased, Brain natriuretic peptide, C-reactive protein increased, Cellulitis, Culture wound negative, Death, Dehydration, Depressed level of consciousness, Dysphagia, Electroencephalogram abnormal, Encephalopathy, Endotracheal intubation, Fibrin D dimer increased, Fracture, General physical health deterioration, Haematocrit decreased, Haemodialysis, Haemoglobin decreased, Hyporeflexia, Immunoglobulin therapy, Klebsiella infection, Leukocytosis, Lymphadenitis, Mechanical ventilation, Muscle contracture, Muscle spasms, Muscular weakness, Musculoskeletal stiffness, Neuromyopathy, Nuclear magnetic resonance imaging abnormal, Pain, Parenteral nutrition, Pneumonia aspiration, Renal failure acute, Renal failure chronic, Renal impairment, Renal tubular necrosis, Rhabdomyolysis, Sepsis, Septic shock, Shift to the left, Tetanus, Transfusion, Ultrasound kidney normal, Urinary tract infection, Ventilation/perfusion scan abnormal, White blood cell count increased, Wound infection
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), 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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Osteoporosis/osteopenia (broad), Renovascular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2011-02-26
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. suffered a fall about 2 weeks ago and had abrasion and received tetanus vaccine and about 48 hours post vaccination she became extremely weak with dysphagia and increased muscle spasm.

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