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This is VAERS ID 56851

Case Details

VAERS ID: 56851 (history)  
Form: Version 1.0  
Age: 47.0  
Sex: Male  
Location: Maryland  
Vaccinated:1993-10-28
Onset:1993-10-29
   Days after vaccination:1
Submitted: 1993-10-29
   Days after onset:0
Entered: 1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-29
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


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