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This is VAERS ID 47149

Case Details

VAERS ID: 47149 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: South Dakota  
Vaccinated:1992-10-13
Onset:1992-10-24
   Days after vaccination:11
Submitted: 1992-10-30
   Days after onset:6
Entered: 1992-11-12
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928223 / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-26
   Days after onset: 2
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: Trazadone, Tedrol, Prosom, Buspar
Current Illness: chronic bronchitis-alzheimers
Preexisting Conditions: PCN, Novacaine-alzheimers
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up:


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