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This is VAERS ID 106152

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 106152 (history)  
Form: Version .0  
Age: 63.6  
Sex: Male  
Location: Wisconsin  
Vaccinated:1997-11-06
Onset:1997-11-06
   Days after vaccination:0
Submitted: 1997-12-04
   Days after onset:28
Entered: 1998-01-08
   Days after submission:35
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1997-1998 / WYETH 4978172 / - LA / -

Administered by: Public       Purchased by: Unknown
Symptoms: INFARCT MYOCARD
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-06
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax @ work place a/2:15;did not report any s/s of feeling ill either before or p/inj;lt for break 330PM & had MI during break;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=106152


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