VAERS ID: |
46704 (history) |
Form: |
Version 1.0 |
Age: |
64.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 1992-10-02 |
Onset: | 1992-10-03 |
Days after vaccination: | 1 |
Submitted: |
1992-10-08 |
Days after onset: | 5 |
Entered: |
1992-11-05 |
Days after submission: | 28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01272P / UNK |
- / IM |
Administered by: Public Purchased by: Other Symptoms: Cardiac arrest SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: n/s Current Illness: n/s Preexisting Conditions: n/s Allergies: Diagnostic Lab Data: n/s CDC Split Type: 924092014
Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary; |