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This is VAERS ID 160872

Case Details

VAERS ID: 160872 (history)  
Form: Version 1.0  
Age: 55.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2000-10-09
Onset:2000-10-09
   Days after vaccination:0
Submitted: 2000-10-18
   Days after onset:9
Entered: 2000-10-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring
SMQs:, Anaphylactic reaction (broad), Disorders of sinus node function (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type: MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothyroidism, and allergies to penicillin, rvp dye, shellfish, and Tegretol.


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