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This is VAERS ID 110547

(NOTE: This result is from the 5/14/2017 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: 1998-05-04
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0923910 / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Syncope, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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). The medical records state loss of consciousness and ventricular fibrillation.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170514&IDNUMBER=110547


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