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This is VAERS ID 42220

Case Details

VAERS ID: 42220 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Male  
Location: Wyoming  
Vaccinated:1991-10-18
Onset:1991-10-21
   Days after vaccination:3
Submitted: 1991-10-22
   Days after onset:1
Entered: 1992-05-28
   Days after submission:219
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 2 LA / IM

Administered by: Other       Purchased by: Public
Symptoms: Apnoea
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


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