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This is VAERS ID 38734

Case Details

VAERS ID: 38734 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-10-13
Onset:1991-10-13
   Days after vaccination:0
Submitted: 1991-12-05
   Days after onset:53
Entered: 1992-01-13
   Days after submission:39
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Chest pain, Dyspnoea, Haematemesis, Hyperhidrosis, Pallor, Right ventricular failure, Tremor
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-15
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: pt had diabetes, congestive heart failure & a peptic ulcer;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891361005J

Write-up: w/in hrs of receiving flu vax pt began shaking & exp vomiting w/a small amount of blood noted; following morning pt exp chest pain, SOB, paleness & clamminess; pt was hospitalized & died 15OCT91; COD congestive heart failure;


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