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This is VAERS ID 161790

Case Details

VAERS ID: 161790 (history)  
Form: Version 1.0  
Age: 94.0  
Sex: Male  
Location: Oklahoma  
   Days after vaccination:5
Submitted: 2000-11-10
   Days after onset:2
Entered: 2000-11-13
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Public
Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Akathisia (broad), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2001-02-07
   Days after onset: 91
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:
Other Medications: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 states the pt passed away on 2/7/01. Cause of Death - pneumonia.

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