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This is VAERS ID 39745

Case Details

VAERS ID: 39745 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Female  
Location: Hawaii  
Vaccinated:1991-10-29
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 - / IM

Administered by: Other       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC Split Type: HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


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