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This is VAERS ID 58061

Case Details

VAERS ID: 58061 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: West Virginia  
   Days after vaccination:5
Submitted: 1993-11-16
   Days after onset:35
Entered: 1993-12-09
   Days after submission:23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-08
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? Yes
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC Split Type: MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;

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