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This is VAERS ID 47668

Case Details

VAERS ID: 47668 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1992-10-09
Onset:1992-10-21
   Days after vaccination:12
Submitted: 1992-10-26
   Days after onset:5
Entered: 1992-12-03
   Days after submission:38
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 1 LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308913 / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: 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 (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MS9256

Write-up: pt had massive coronary & died on 21OCT92;


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