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This is VAERS ID 58384

(NOTE: This result is from the 8/14/2018 version of the VAERS database)

Case Details

VAERS ID: 58384 (history)  
Form: Version 1.0  
Age: 25.0  
Sex: Female  
Location: North Dakota  
Vaccinated:1993-10-13
Onset:1993-11-29
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41148 / UNK - / IM

Administered by: Military       Purchased by: Military
Symptoms: Endocarditis, Haematemesis, Haemorrhage, Infection, Leukopenia, Lymphadenopathy, Necrosis, Pneumonia
SMQs:, Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Gastrointestinal haemorrhage (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-11-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: waiting on drug screen
CDC Split Type: CO5196

Write-up: found dead in apartment, no suspicious circumstances. Autopsy results: lymphoma; no known cause of death.


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