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This is VAERS ID 46250

Case Details

VAERS ID: 46250 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Michigan  
Vaccinated:1988-11-15
Onset:1989-01-17
   Days after vaccination:63
Submitted: 1992-10-07
   Days after onset:1358
Entered: 1992-10-19
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 1108P / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection, Influenza
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 924090027

Write-up: pt recvd flu vax & was 1 of 5 pts who devel influenza & died;


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