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This is VAERS ID 58089

Case Details

VAERS ID: 58089 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
   Days after vaccination:12
Submitted: 1993-11-12
   Days after onset:6
Entered: 1993-12-09
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis
SMQs:, Agranulocytosis (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Diagnostic Lab Data: NONE
CDC Split Type: PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;

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