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From the 2/18/2021 release of VAERS data:

This is VAERS ID 115910

Case Details

VAERS ID: 115910 (history)  
Form: Version 1.0  
Age: 61.0  
Sex: Male  
Location: Virginia  
Vaccinated:1998-10-29
Onset:1998-10-29
   Days after vaccination:0
Submitted: 1998-11-04
   Days after onset:6
Entered: 1998-11-06
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


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