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This is VAERS ID 106403

Case Details

VAERS ID: 106403 (history)  
Form: Version 1.0  
Age: 90.0  
Sex: Male  
Location: Unknown  
Vaccinated:1997-10-13
Onset:1997-10-13
   Days after vaccination:0
Submitted: 1997-10-20
   Days after onset:7
Entered: 1998-01-15
   Days after submission:87
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-10-13
   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: Lanoxin;lasix;K-Dur;Allopurinol;
Current Illness: metastatic melanoma;
Preexisting Conditions: hx of CHF;metastatic melanoma;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt followed for metastatic melanoma recv flu vax & apparently had sudden death approx 45min later;no prev rxn to flu vax;


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