| VAERS ID: |
46526 (history) |
| Form: |
Version 1.0 |
| Age: |
56.0 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 1992-10-12 |
| Onset: | 1992-10-14 |
| Days after vaccination: | 2 |
| Submitted: |
1992-10-16 |
| Days after onset: | 2 |
| Entered: |
1992-10-28 |
| Days after submission: | 12 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4928234 / UNK |
- / - |
Administered by: Private Purchased by: Other
Symptoms: Apnoea,
Cardiomegaly,
Confusional state,
Hypotension,
Leukocytosis,
Myocardial infarction,
Pulmonary oedema,
Vascular occlusion
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 1992-10-16
Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: following Hemodialysis
Preexisting Conditions: pt had chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC Split Type: 892293001E
Write-up: pt recvd flu vax & devel sudden onset of hypotension, hypoglycemia & chills; pt suffered a cardiac arrest & was hospitalized & died; |
