National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 12/31/2003 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 150155

Government Disclaimer on use of this data



Case Details

VAERS ID: 150155 (history)  
Form: Version .0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:1999-11-15
Onset:1999-11-20
   Days after vaccination:5
Submitted: 2000-03-08
   Days after onset:109
Entered: 2000-04-11
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1998-1999 / CONNAUGHT LABS U0163AA / - RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: HALLUCIN, HEADACHE
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died". no other info provided.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=150155


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166