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This is VAERS ID 1006029

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1006029
VAERS Form:2
Age:5.0
Sex:Male
Location:Texas
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7108NA / 6 LL / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Syncope, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamin
Current Illness: none
Preexisting Conditions: expressive language delay
Allergies: none
Diagnostic Lab Data: I do not have records from the ED to know what they did
CDC 'Split Type':

Write-up: Patient had a syncopal event at night about 2 1/2 weeks after vaccination. He was found unresponsive the next morning and taken to ER, where he could not be revived.


Changed on 5/7/2021

VAERS ID: 1006029 Before After
VAERS Form:2
Age:5.0
Sex:Male
Location:Texas
Vaccinated:2021-01-14
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7108NA / 6 LL / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Syncope, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamin
Current Illness: none
Preexisting Conditions: expressive language delay
Allergies: none none
Diagnostic Lab Data: I do not have records from the ED to know what they did
CDC 'Split Type':

Write-up: Patient had a syncopal event at night about 2 1/2 weeks after vaccination. He was found unresponsive the next morning and taken to ER, where he could not be revived.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1006029&WAYBACKHISTORY=ON


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