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This is VAERS ID 476377

Case Details

VAERS ID: 476377 (history)  
Form: Version 1.0  
Age: 89.0  
Sex: Female  
Location: New York  
Vaccinated:2012-10-02
Onset:2012-10-14
   Days after vaccination:12
Submitted: 2012-12-04
   Days after onset:51
Entered: 2012-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4489AA / UNK LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Anaemia, Blood culture, Blood test, Candidiasis, Chest X-ray, Computerised tomogram, Culture urine, Death, Echocardiogram, Fatigue, Full blood count, Hyperhidrosis, Malaise, Pyrexia, Ultrasound scan, Urine analysis
SMQs:, Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-11-30
   Days after onset: 47
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg, Metoprolol ER 25mg, Isosorbide mononitrate 60mg, Fluoxetine 20mg, Hydrocodone/APAP 7.5/500, Omeprazole 20mg, ASA 81mg, Lidoderm patch 5%, Pravastatin 40mg.
Current Illness: None specifically known.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data: Blood cultures, blood analysis (CBC, etc), urine cultures and analysis, CT scans, chest x-rays, sonogram, echo-cardiogram, and possibly more tests were given.
CDC Split Type:

Write-up: Fevers (102.6 max), sweating, fatigue, malaise, anemia, thrush. Adverse effects lasted until day of death.


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