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This is VAERS ID 58157

Case Details

VAERS ID: 58157 (history)  
Form: Version 1.0  
Age: 59.0  
Sex: Male  
Location: Illinois  
Vaccinated:1993-10-15
Onset:1993-10-23
   Days after vaccination:8
Submitted: 1993-11-29
   Days after onset:37
Entered: 1993-12-13
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

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: UNK~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


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