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This is VAERS ID 39742

Case Details

VAERS ID: 39742 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Female  
Location: Hawaii  
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted: 1991-11-25
Entered: 1992-03-02
   Days after submission:98
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-09
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC Split Type: HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


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