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This is VAERS ID 468865

Case Details

VAERS ID: 468865 (history)  
Form: Version 1.0  
Age: 86.0  
Sex: Male  
Location: Ohio  
Vaccinated:2012-10-03
Onset:2012-10-04
   Days after vaccination:1
Submitted: 2012-10-10
   Days after onset:6
Entered: 2012-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204201 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-10-04
   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: vitamin D, mirtazapine, omeprazole, hydrochlorothiazide, loratadine, tramadol, docusate
Current Illness: no infectious illnesses at time of vaccination
Preexisting Conditions: NKDA Adult Failure to Thrive Esophageal stricture, HTN, Osteoarthritis, Dementia
Allergies:
Diagnostic Lab Data: Pt had chronic illnesses including being very malnourished, weighing 102# and being 6''2".
CDC Split Type:

Write-up: Per family pt had a good day and eve, no signs of allergic reaction or difficulty. He failed to wake up the next morning. Time of death 10:37 AM.


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