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This is VAERS ID 38150

Case Details

VAERS ID: 38150 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:1991-12-04
Onset:1991-12-04
   Days after vaccination:0
Submitted: 1991-12-20
   Days after onset:16
Entered: 1991-12-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / UNK LA / -

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-12-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No~ ()~~~In patient
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


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