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This is VAERS ID 83553

Case Details

VAERS ID: 83553 (history)  
Form: Version 1.0  
Age: 82.0  
Sex: Female  
Location: Georgia  
Vaccinated:1995-10-27
Onset:1995-10-29
   Days after vaccination:2
Submitted: 1995-11-01
   Days after onset:3
Entered: 1996-03-11
   Days after submission:131
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958139 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-10-29
   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:
Preexisting Conditions: arhtritis
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA96001

Write-up: deceased 28OCT95


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