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This is VAERS ID 113727

Case Details

VAERS ID: 113727 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Male  
Location: New York  
Submitted: 1998-08-21
Entered: 1998-08-31
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Leukopenia, Pyrexia
SMQs:, Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pt treated for multiple myeloma;
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: U199800494

Write-up: It was reported that pt (no other specifices reported) recv vax about 2wk prior to the report date of 21AUG98;some time p/vax pt adm to hosp w/fever & leukopenia;It was reportedthat prior to recv vax pt was recently treated for mult myeloma

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