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This is VAERS ID 115255

Case Details

VAERS ID: 115255 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Kentucky  
Vaccinated:1998-10-13
Onset:1998-10-14
   Days after vaccination:1
Submitted: 1998-10-20
   Days after onset:6
Entered: 1998-10-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981800 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-14
   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: U199800667

Write-up: pt recv vax 13OCT98 & 14OCT98 pt committed suicide gun shot wound to head;


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