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This is VAERS ID 105197

Case Details

VAERS ID: 105197 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Male  
Location: Kentucky  
Vaccinated:1997-10-23
Onset:1997-11-17
   Days after vaccination:25
Submitted: 1997-11-18
   Days after onset:1
Entered: 1997-11-28
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 4 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Cardiovascular disorder, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


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