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This is VAERS ID 47189

Case Details

VAERS ID: 47189 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: New York  
Vaccinated:1992-10-28
Onset:1992-11-03
   Days after vaccination:6
Submitted: 1992-11-09
   Days after onset:6
Entered: 1992-11-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928217 / 1 LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Cough, Hypertension, Hypotension, Malaise, Muscle twitching, Respiratory disorder, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-03
   Days after onset: 0
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: Prozac, Synthroid, Trental, Tylenol, ASA, Senokot, Mult vit, Dulcolax;
Current Illness: NONE
Preexisting Conditions: no allergies-CVA rt hemopoisis, mild depression, plural effusions''
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: laughing, talking & eating well 2NOV92; 3NOV92 wake & vomited BP 180/110, P 100; 550 became listless, BP 75/50, P diff to count; twitching


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