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This is VAERS ID 39744

Case Details

VAERS ID: 39744 (history)  
Form: Version 1.0  
Age: 92.0  
Sex: Male  
Location: Hawaii  
Vaccinated:1991-10-28
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: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


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