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This is VAERS ID 26318

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 26318 (history)  
Form: Version .0  
Age: 92.0  
Sex: Female  
Location: Alabama  
Vaccinated:1990-10-09
Onset:1990-10-11
   Days after vaccination:2
Submitted: 1990-10-17
   Days after onset:6
Entered: 1990-10-22
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 89-90) / CONNAUGHT LABORATORIES 0F11216 / 0 A / IM

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-12
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC Split Type:

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=26318


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