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This is VAERS ID 107361

(NOTE: This result is from the 5/14/2017 version of the VAERS database)

Case Details

VAERS ID: 107361 (history)  
Form: Version .0  
Age: 40.0  
Sex: Male  
Location: Louisiana  
Vaccinated:1996-10-31
Onset:1996-11-05
   Days after vaccination:5
Submitted: 1998-01-26
   Days after onset:447
Entered: 1998-02-10
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other       Purchased by: Other
Symptoms: Coma, Diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-05
   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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170514&IDNUMBER=107361


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