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This is VAERS ID 58410

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 58410 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:1993-12-14
Onset:1993-12-14
   Days after vaccination:0
Submitted: 1993-12-15
   Days after onset:1
Entered: 1993-12-27
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 1 - / A

Administered by: Private       Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-12-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


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