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This is VAERS ID 48415

Case Details

VAERS ID: 48415 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Female  
Location: Georgia  
Vaccinated:1992-10-08
Onset:1992-10-12
   Days after vaccination:4
Submitted: 1992-10-15
   Days after onset:3
Entered: 1992-12-23
   Days after submission:69
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928243 / 3 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Cardiovascular disorder, Myocardial infarction, Nausea, Shock
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-12
   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:
Current Illness: hx of coronary problems
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA92210

Write-up: 930AM 12OCT92 MD office w/nausea, weak; hx of heart disease; BP 162/50-sent ot ER expired 1152 12OCT92 w/prob dx of myocardial infarction;


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