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This is VAERS ID 26159

Case Details

VAERS ID: 26159 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Female  
Location: Arizona  
Vaccinated:1990-09-20
Onset:1990-09-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-09-20
   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: Methyprednisolone, Verapamil, Proventil, Albuterol, Anhydrous Theophylline
Current Illness: Severe Bronchial Asthma
Preexisting Conditions: Pt was hospitalized 2-3 yrs ago for hypertensive Crisis & Severe Bronchial Asthma.
Allergies:
Diagnostic Lab Data: HGT=5''6"; WGT=99lbs; Morning of 20SEP90 BP=142/86;P=72/min®.
CDC Split Type: 904090001

Write-up: Pt vaccinated with FLUOGEN who has severe bronchial asthma seen in MD ofc well VS stable & chest clear, death & respiratory arrest.


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