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Report #2887159

Received Feb 27, 2026

DiedER / ED visit
A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex
Female
Age
91 yrs
State
IN
Recovered
Not recovered
Vaccinated
Jan 12, 2026
Onset
Jan 17, 2026
Days to onset
5
Hospital days

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
FLU3INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURN/Au8855caIM / LA

Symptoms (21)

Anaphylaxis treatmentBlood gasesBradycardiaCardiac arrestCentral venous catheterisationCondition aggravatedDeathDyspnoeaEndotracheal intubationFull blood countHernia painHypotensionLaboratory testMalaiseMydriasisNear death experiencePulse absentPupil fixedResuscitationTachycardiaUnresponsive to stimuli

Symptom narrative

Patient family called 911 due to "feeling unwell". Patient with shortness of breath on EMS arrival. Stated it started 4 hours prior to 911 call. Patient complained to family about worsening hernia pain, and generally unwell. Also with difficulty breathing. On arrival to ED patient become unresponsive and then had cardiac arrest. Patient arrived to ED at 2250 . The following is from the ED physician note: on arrival, patient is hypotensive, tachycardic, and in extremis. By the time of my examination, patient unresponsive, no pulse found, CPR / ACLS algorithm started. Patient given multiple rounds of epinephrine and ROSC was obtained at one point. Patient was intubated on 2nd attempt, and a left subclavian venous catheter was placed. Patient became bradycardic, and again pulses were lost, CPR re-initiated. ROSC was not achieved again. Discussion with family at bedside, patient's daughter only medical care proxy advised to have extremely poor prognosis. Patient's daughter said okay to stop CPR after informing her that his pupils were fixed and dilated, in her heart was not beating on its own at this time. time of death called at 12:26 a.m.

Current illness

1) Hypertension: Code(s): I10 - Essential (primary) hypertension Status: Chronic Plan: Typically well controlled. Continue current treatment. Follow up in 4 months, sooner if needed. (2) Diabetes mellitus: Code(s): E11.9 - Type 2 diabetes mellitus without complications Status: Chronic Plan: Check A1c. We will also send an order for a new glucometer. (3) Hyperlipidemia: Code(s): E78.5 - Hyperlipidemia, unspecified Status: Acute Plan:

Medical history

Anxiety (Chronic Medical) F41.9 Diabetes mellitus (Chronic Medical) E11.9 Gastroesophageal reflux (Acute Medical) K21.9 Hyperlipidemia (Acute Medical) E78.5 Hypertension (Chronic Medical) I10 Stage 3 chronic kidney disease (Acute Medical) N18.30 Umbilical hernia (Chronic Medical) K42.9

Other medications

fluticasone propionate 50 2 spray intranasal QDAY #16 grams 02/02/23 01/12/26 Rx mcg/actuation nasal spray,suspension (Flonase Allergy Relief) polyethylene glycol 3350 17 17 g PO QDAY PRN Constipation 06/12/23 01/12/26 History g

Allergies

codeine Allergy (Verified 01/12/26 14:34) Unknown sulfamethoxazole (From Bactrim) Allergy (Verified 01/12/26 14:34) Rash trimethoprim (From Bactrim) Allergy (Verified 01/12/26 14:34) Rash

Lab data

CBC, Blood Gas, Chemistry