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This is VAERS ID 480899

Case Details

VAERS ID: 480899 (history)  
Form: Version 1.0  
Age: 89.0  
Sex: Male  
Location: Florida  
Vaccinated:2013-01-07
Onset:2013-01-07
   Days after vaccination:0
Submitted: 2013-01-10
   Days after onset:3
Entered: 2013-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4542AA / 2 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Death, Diarrhoea, Viral infection, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Latanoprost eye drops, tamsulosin, possibly other, patient uses other pharmacies also
Current Illness: None reported at time of vaccination
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Neighbor reported that the patient died 1-7-13. Inital cause has been diagnosed as vomiting and diarrhea probably caused by a virus. Due to its close approximation to vaccination I am reporting this incident.


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