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This is VAERS ID 94611

Case Details

VAERS ID: 94611 (history)  
Form: Version 1.0  
Age: 81.0  
Sex: Male  
Location: New Jersey  
Vaccinated:1996-11-21
Onset:1996-11-23
   Days after vaccination:2
Submitted: 1997-01-29
   Days after onset:67
Entered: 1997-01-31
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Dysphagia, Haemorrhage, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Gastrointestinal ulceration (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-17
   Days after onset: 55
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 56 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC Split Type: MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


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