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This is VAERS ID 86285

Case Details

VAERS ID: 86285 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Male  
Location: Florida  
Vaccinated:1995-12-18
Onset:1995-12-19
   Days after vaccination:1
Submitted: 1996-01-02
   Days after onset:14
Entered: 1996-05-23
   Days after submission:141
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (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 (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1995-12-23
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure


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