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This is VAERS ID 56467

Case Details

VAERS ID: 56467 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:1993-09-30
Onset:1993-10-01
   Days after vaccination:1
Submitted: 1993-10-02
   Days after onset:1
Entered: 1993-10-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938137 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 340938 / 1 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, 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 (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-01
   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: Sinemet; Parlodel, Xanax, Doxepin, Furosemide, ASA, Paxil
Current Illness: parkinsons, skin (contact derm);
Preexisting Conditions: sulfa/motrin advanced parkinsons disease;
Allergies:
Diagnostic Lab Data: last labs 20AUG93 Serum NA 127; serum CA+ 8.5; chlorids 88;
CDC Split Type:

Write-up: resp/cardiac arrest;


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