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This is VAERS ID 56603

Case Details

VAERS ID: 56603 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: California  
Vaccinated:1993-09-30
Onset:1993-09-30
   Days after vaccination:0
Submitted: 1993-10-01
   Days after onset:1
Entered: 1993-10-15
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 1 - / IM A

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-09-30
   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: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


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