| 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 |
