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This is VAERS ID 58095

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 58095 (history)  
Form: Version .0  
Age: 79.7  
Sex: Female  
Location: South Carolina  
   Days after vaccination:1
Submitted: 1993-11-24
   Days after onset:21
Entered: 1993-12-16
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 / CONNAUGHT LABS 3F41007 / - LA / IM

Administered by: Public       Purchased by: Unknown

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-15
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: unk
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;

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