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This is VAERS ID 86649

Case Details

VAERS ID: 86649 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Maryland  
Vaccinated:1995-11-27
Onset:1995-11-29
   Days after vaccination:2
Submitted: 1996-02-05
   Days after onset:68
Entered: 1996-06-03
   Days after submission:118
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958066 / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Malaise
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-11-29
   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: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


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