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This is VAERS ID 47309

Case Details

VAERS ID: 47309 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1992-11-02
Onset:1992-11-02
   Days after vaccination:0
Submitted: 1992-11-04
   Days after onset:2
Entered: 1992-11-17
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / UNK - / IM

Administered by: Military       Purchased by: Military
Symptoms: Apnoea, 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 (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-11-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: could not breath went into full arrest;


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