National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 36623

Case Details

VAERS ID: 36623 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1991-10-07
Onset:1991-10-20
   Days after vaccination:13
Submitted: 1991-11-07
   Days after onset:18
Entered: 1991-11-25
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 4 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Hyperglycaemia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC Split Type: SD91025

Write-up: 20OCT91 pt expired;


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=36623


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166