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This is VAERS ID 38163

Case Details

VAERS ID: 38163 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:1991-11-06
Onset:1991-11-08
   Days after vaccination:2
Submitted: 1991-11-15
   Days after onset:7
Entered: 1991-12-30
   Days after submission:45
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 6 - / -

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


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