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This is VAERS ID 110547

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

Case Details

VAERS ID: 110547 (history)  
Form: Version .0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:1998-04-07
Onset:1998-04-07
   Days after vaccination:0
Submitted: 1998-04-08
   Days after onset:1
Entered: 1998-05-06
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED, ADULTS / CONNAUGHT LABS 0923910 / 2 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: APNEA, COMA, FIBRILLAT VENT, HEART ARREST
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-04-07
   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: Azulfidine, HCTZ, Cardizem, Synthroid;
Current Illness: NONE
Preexisting Conditions: ulcerative colitis, asthma, CAD;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: (null)


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=110547


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