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. |