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This is VAERS ID 39281

Case Details

VAERS ID: 39281 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:1991-11-13
Onset:1991-11-18
   Days after vaccination:5
Submitted: 1992-01-16
   Days after onset:59
Entered: 1992-01-31
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia
SMQs:, Agranulocytosis (broad), Gastrointestinal perforation (narrow), Oropharyngeal infections (narrow), Ischaemic colitis (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-26
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


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