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This is VAERS ID 57612

Case Details

VAERS ID: 57612 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:1993-10-23
Onset:1993-10-23
   Days after vaccination:0
Submitted: 1993-11-10
   Days after onset:18
Entered: 1993-11-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-23
   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:
Current Illness: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


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