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This is VAERS ID 58135

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

Case Details

VAERS ID: 58135 (history)  
Form: Version .0  
Age: 73.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1993-12-07
Entered: 1993-12-20
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1993-1994 / PARKE-DAVIS - / 3 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: EFFUS PERICARD, HEM LUNG, INFECT, MARROW HYPERPLASIA, PNEUMONIA
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=58135


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