This is VAERS ID 467090

(NOTE: This result is from the 10/14/2018 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=20181014&IDNUMBER=467090