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This is VAERS ID 47310

Case Details

VAERS ID: 47310 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Female  
Location: North Carolina  
Vaccinated:1992-11-02
Onset:1992-11-03
   Days after vaccination:1
Submitted: 1992-11-04
   Days after onset:1
Entered: 1992-11-17
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2F311704 / UNK - / IM

Administered by: Private       Purchased by: Private
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: 1992-11-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin, Clinoril med, for hypertension;
Current Illness: diabetes/hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: found on floor @ home in full arrest;


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