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This is VAERS ID 467090

(NOTE: This result is from the 6/14/2018 version of the VAERS database)

Case Details

VAERS ID: 467090 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Male  
Location: Missouri  
Vaccinated:2012-09-24
Onset:2012-09-24
   Days after vaccination:0
Submitted: 2012-10-01
   Days after onset:7
Entered: 2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58406 / UNK - / IM

Administered by: Other       Purchased by: Public
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-09-28
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: None
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: unknown.
CDC Split Type:

Write-up: Pt daughter reported next day that explosive diarrhea occurred. Recommended ER or urgent care.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180614&IDNUMBER=467090


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