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This is VAERS ID 26463

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

Case Details

VAERS ID: 26463 (history)  
Form: Version .0  
Age: 62.9  
Sex: Female  
Location: Michigan  
Vaccinated:1990-10-01
Onset:1990-10-01
   Days after vaccination:0
Submitted: 1990-10-17
   Days after onset:16
Entered: 1990-11-07
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908209 / - LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: APNEA, ATELECTASIS, FEVER, FLU SYND, HYPOVENTIL
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-16
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC Split Type:

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


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