VAERS ID: |
26463 (history) |
Form: |
Version .0 |
Age: |
62.0 |
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 |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
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), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: ~ ()~~~In patient 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 |