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This is VAERS ID 26713

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

Case Details

VAERS ID: 26713 (history)  
Form: Version .0  
Age: 77.0  
Sex: Male  
Location: Maryland  
Vaccinated:1990-10-02
Onset:1990-10-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 02580P / - - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: APNEA, HEART ARREST, PNEUMONIA, SHOCK
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-09
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & ""a lump in his chest"" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=26713


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