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This is VAERS ID 465916

Case Details

VAERS ID: 465916 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Male  
Location: Texas  
Vaccinated:2012-09-20
Onset:2012-09-21
   Days after vaccination:1
Submitted: 2012-09-21
   Days after onset:0
Entered: 2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4494AA / UNK UN / IM

Administered by: Other       Purchased by: Public
Symptoms: Activities of daily living impaired, Death, Faecal incontinence, Musculoskeletal stiffness, Pain
SMQs:, Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Noninfectious diarrhoea (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-09-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 50mg daily
Current Illness: No chronic disease noted
Preexisting Conditions: Diabetes; Hypertension
Allergies:
Diagnostic Lab Data: Since flu vaccine was adminstered within such a close timeframe, medical examiner thought that we should be aware and report to VAERS, the possible link of the vaccine to the patient''s death.
CDC Split Type:

Write-up: Patient complained of "achiness" around 2:30 to 3:00 pm. His symptoms progressed to stiffness and soreness by bedtime and needed help with his clothing before bed. Around Midnight, there was a loss of bowel control and he passed away.


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