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This is VAERS ID 90265

Case Details

VAERS ID: 90265 (history)  
Form: Version 1.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:1996-09-18
Onset:1996-09-22
   Days after vaccination:4
Submitted: 1996-09-27
   Days after onset:5
Entered: 1996-09-30
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-09-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO6786

Write-up: death, flu-like sx 3 days p/shot;


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