National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 103592

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 103592
VAERS Form:
Age:22.4
Sex:Male
Location:Pennsylvania
Vaccinated:1997-10-16
Onset:1997-10-17
Submitted:1997-10-22
Entered:1997-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1997-1998 / CONNAUGHT LABS 7F81820 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


Changed on 12/8/2009

VAERS ID: 103592 Before After
VAERS Form:
Age:22.4
Sex:Male
Location:Pennsylvania
Vaccinated:1997-10-16
Onset:1997-10-17
Submitted:1997-10-22
Entered:1997-10-29 1997-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1997-1998 INFLUENZA (SEASONAL) (FLUZONE 97-98) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7F81820 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


Changed on 8/31/2010

VAERS ID: 103592 Before After
VAERS Form:
Age:22.4
Sex:Male
Location:Pennsylvania
Vaccinated:1997-10-16
Onset:1997-10-17
Submitted:1997-10-22
Entered:1997-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 97-98) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


Changed on 7/7/2013

VAERS ID: 103592 Before After
VAERS Form:
Age:22.4
Sex:Male
Location:Pennsylvania
Vaccinated:1997-10-16
Onset:1997-10-17
Submitted:1997-10-22
Entered:1997-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


Changed on 2/14/2017

VAERS ID: 103592 Before After
VAERS Form:
Age:22.4 22.0
Sex:Male
Location:Pennsylvania
Vaccinated:1997-10-16
Onset:1997-10-17
Submitted:1997-10-22
Entered:1997-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


Changed on 5/14/2017

VAERS ID: 103592 Before After
VAERS Form:
Age:22.0
Sex:Male
Location:Pennsylvania
Vaccinated:1997-10-16
Onset:1997-10-17
Submitted:1997-10-22
Entered:1997-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


Changed on 9/14/2017

VAERS ID: 103592 Before After
VAERS Form:(blank) 1
Age:22.0
Sex:Male
Location:Pennsylvania
Vaccinated:1997-10-16
Onset:1997-10-17
Submitted:1997-10-22
Entered:1997-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


Changed on 2/14/2018

VAERS ID: 103592 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:Pennsylvania
Vaccinated:1997-10-16
Onset:1997-10-17
Submitted:1997-10-22
Entered:1997-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


Changed on 6/14/2018

VAERS ID: 103592 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:Pennsylvania
Vaccinated:1997-10-16
Onset:1997-10-17
Submitted:1997-10-22
Entered:1997-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


Changed on 8/14/2018

VAERS ID: 103592 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:Pennsylvania
Vaccinated:1997-10-16
Onset:1997-10-17
Submitted:1997-10-22
Entered:1997-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


Changed on 9/14/2018

VAERS ID: 103592 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:Pennsylvania
Vaccinated:1997-10-16
Onset:1997-10-17
Submitted:1997-10-22
Entered:1997-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;


Changed on 10/14/2018

VAERS ID: 103592 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:Pennsylvania
Vaccinated:1997-10-16
Onset:1997-10-17
Submitted:1997-10-22
Entered:1997-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81820 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: fever of unk origin;
Preexisting Conditions: Duchenne type muscular dystrophy;recent dental surgery;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7668

Write-up: pt recv vax OCT97 & pt was reportedly febrile;pt was 1 of 2 people vaccinated from the same household both of whom were dx w/Duchenne type muscular dystrophy;both pt suffered from chronic fevers of unk origin;pt hosp & expired;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=103592&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166