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This is VAERS ID 46704

Case Details

VAERS ID: 46704 (history)  
Form: Version 1.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1992-10-02
Onset:1992-10-03
   Days after vaccination:1
Submitted: 1992-10-08
   Days after onset:5
Entered: 1992-11-05
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

Administered by: Public       Purchased by: Other
Symptoms: Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (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: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC Split Type: 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


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