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: |
1990-11-02 |
Days after submission: | 16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) / WYETH PHARMACEUTICALS, INC |
4908209 / - |
LA / IM |
Administered by: Private Purchased by: Other Symptoms: Apnoea,
Atelectasis,
Hypoventilation,
Influenza,
Pneumonia,
Pyrexia,
Rhinitis SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad)
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: 890291001B
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 |