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This is VAERS ID 92463

Case Details

VAERS ID: 92463 (history)  
Form: Version 1.0  
Age: 95.0  
Sex: Male  
Location: Arizona  
Vaccinated:1996-10-27
Onset:1996-10-31
   Days after vaccination:4
Submitted: 1996-11-01
   Days after onset:1
Entered: 1996-11-29
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-31
   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: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type: 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


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