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From the 5/7/2021 release of VAERS data:

This is VAERS ID 889126



Case Details

VAERS ID: 889126 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Michigan  
Vaccinated:2007-12-01
Onset:2007-12-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Device related infection, Paralysis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USSA2020SA276156

Write-up: paralyzed from neck down; fever; an infection related to catheter; Initial information was received on 05-Oct-2020 regarding an unsolicited valid serious case from a consumer/non-health care professional (caregiver). This case involves an 89 years old male patient who was paralyzed from his neck down (paralysis), had a fever (pyrexia) and died due to an infection related to catheter (device related infection), while he received INFLUENZA VACCINE. Medical history, medical treatment(s), vaccination(s), concomitant medications and family history were not provided. On an unknown date in Dec-2007, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer (lot number and expiry date not reported) once via an unknown route in unknown administration site for prophylactic vaccination. On an unknown date, the patient was paralyzed from neck down (paralysis) 5 hours following the administration of INFLUENZA VACCINE. He was taken to the hospital for 2 days and got back the use of everything but his legs, and then the hospital discharged him to a rehabilitation center that was more reactive, than preventative. The event paralysis was assessed as medically significant. Case details: The family (2 nurses in the family) felt that the patient had Guillen''s Barre, however this was never officially diagnosed. The patient died in the rehabilitation center within a week due to an infection related to his catheter (device related infection) even though he was not running a fever. At the very end he ran a fever (pyrexia, non-serious event), but they did not put him on the appropriate antibiotics. No autopsy was completed. The event device related infection was assessed as medically significant and led to death. No laboratory data was provided. It was not reported if the patient received a corrective treatment. At the time of report, the outcome of paralysis and pyrexia was unknown while the event device related infection was fatal. The cause of death was reported as device related infection. Information on lot number was requested.; Sender''s Comments: This case involves an 89 years old male patient who had paralysis, pyrexia and died due to device related infection after vaccination with INFLUENZA VACCINE (produced by unknown manufacturer). The time to onset is compatible. Additional information regarding medical history, condition at the time of vaccination, concomitant medications, lab /radiological investigation excluding other etiologies and detail autopsy report would be needed for complete assessment of the case. Based upon the reported information, the role of vaccine cannot be assessed.; Reported Cause(s) of Death: an infection related to catheter


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