| 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; |
