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This is VAERS ID 49057

Case Details

VAERS ID: 49057 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:1992-10-21
Onset:1992-11-07
   Days after vaccination:17
Submitted: 1992-11-23
   Days after onset:16
Entered: 1993-01-14
   Days after submission:52
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Haemorrhage, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC Split Type: 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


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