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This is VAERS ID 96948

Case Details

VAERS ID: 96948 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:1996-10-02
Onset:1996-10-03
   Days after vaccination:1
Submitted: 1996-11-18
   Days after onset:46
Entered: 1997-04-16
   Days after submission:148
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-10-03
   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: Procardia XL 30mg
Current Illness:
Preexisting Conditions: HTN, coronary artery disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax and shortly p/vax died;MD does not feel that the shot contributed to death;pt recv flu vax in past w/no adverse effects;COD MI;


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