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This is VAERS ID 58095

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

Case Details

VAERS ID: 58095 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: South Carolina  
Vaccinated:1993-11-02
Onset:1993-11-03
   Days after vaccination:1
Submitted: 1993-11-24
   Days after onset:21
Entered: 1993-12-09
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

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: ~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: SC93143

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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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180614&IDNUMBER=58095


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