National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 115054

Case Details

VAERS ID: 115054 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1998-10-08
Onset:1998-10-08
   Days after vaccination:0
Submitted: 1998-10-14
   Days after onset:6
Entered: 1998-10-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / IM A

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-08
   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: unk
Current Illness: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800624

Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=115054


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