National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 103592

Case Details

VAERS ID: 103592 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1997-10-16
Onset:1997-10-17
   Days after vaccination:1
Submitted: 1997-10-22
   Days after onset:5
Entered: 1997-10-24
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=103592


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166