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This is VAERS ID 93968

Case Details

VAERS ID: 93968 (history)  
Form: Version 1.0  
Age: 66.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1996-10-24
Onset:1996-10-25
   Days after vaccination:1
Submitted: 1996-11-01
   Days after onset:7
Entered: 1997-01-23
   Days after submission:83
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / UNK - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-25
   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:
Current Illness:
Preexisting Conditions: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC Split Type: MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


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