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This is VAERS ID 29150

Case Details

VAERS ID: 29150 (history)  
Form: Version 1.0  
Age: 87.0  
Sex: Female  
Location: Minnesota  
Vaccinated:1990-10-24
Onset:1990-10-26
   Days after vaccination:2
Submitted: 1990-11-20
   Days after onset:25
Entered: 1991-03-15
   Days after submission:115
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11200 / 2 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Cardiac failure, Myocardial infarction
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MN90002

Write-up: Admitted to hosp on 26OCT90 died on 26OCT90; MI w/cardiac arrest.


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