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This is VAERS ID 96949

Case Details

VAERS ID: 96949 (history)  
Form: Version 1.0  
Age: 78.0  
Sex: Male  
Location: Texas  
Vaccinated:1996-10-28
Onset:1996-10-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Conduction defects (narrow), Embolic and thrombotic events, arterial (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-05
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


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