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This is VAERS ID 58089

(NOTE: This result is from the 8/31/2010 version of the VAERS database)

Case Details

VAERS ID: 58089 (history)  
Form: Version .0  
Age: 65.7  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1993-10-25
Onset:1993-11-06
   Days after vaccination:12
Submitted: 1993-11-12
   Days after onset:6
Entered: 1993-12-09
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 0 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis
SMQs:, Agranulocytosis (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100831&IDNUMBER=58089


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