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This is VAERS ID 478216

Case Details

VAERS ID: 478216 (history)  
Form: Version 1.0  
Age: 91.0  
Sex: Male  
Location: Virginia  
Vaccinated:2012-11-19
Onset:2012-11-21
   Days after vaccination:2
Submitted: 2012-12-16
   Days after onset:25
Entered: 2012-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 1 LA / ID

Administered by: Unknown       Purchased by: Other
Symptoms: Chest X-ray, Cough, Dizziness, Headache, Increased bronchial secretion, Laboratory test, Pleural effusion, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Aenolol, prednisone Merck Sharpe, & D
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data: Chest x-rays, emergency room lab tests, extended hospital stage still going on.
CDC Split Type:

Write-up: Fluid in lungs, persistent rattling cough, excess mucous, headache, fever, dizziness, ....


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