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This is VAERS ID 57008

Case Details

VAERS ID: 57008 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: Arizona  
Vaccinated:1993-09-30
Onset:1993-10-01
   Days after vaccination:1
Submitted: 1993-10-18
   Days after onset:17
Entered: 1993-11-05
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / 4 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Dyspnoea, Hyperventilation, Hypocalcaemia, Leukocytosis, Pneumonia, Pyrexia, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-08
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Prednisone; Methotrexate;
Current Illness:
Preexisting Conditions: pulmonary fibrosis, past hx TB, theumatoid arthritis;
Allergies:
Diagnostic Lab Data: family refused autopsy;
CDC Split Type: CO5040

Write-up: died p/being hospitalized for interstitial pneumonia; day p/vax felt SOB & started to cough; 5OCt admitted;


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