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This is VAERS ID 105197

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 105197
VAERS Form:
Age:67.5
Sex:Male
Location:Kentucky
Vaccinated:1997-10-23
Onset:1997-11-17
Submitted:1997-11-18
Entered:1997-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1997-1998 / WYETH 4978145 / 3 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: STUPOR, CARDIOVASC DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-17
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


Changed on 12/8/2009

VAERS ID: 105197 Before After
VAERS Form:
Age:67.5
Sex:Male
Location:Kentucky
Vaccinated:1997-10-23
Onset:1997-11-17
Submitted:1997-11-18
Entered:1997-12-01 1997-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1997-1998 INFLUENZA (SEASONAL) (FLUSHIELD 97-98) / WYETH WYETH PHARMACEUTICALS, INC 4978145 / 3 LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Cardiovascular disorder, Stupor, STUPOR, CARDIOVASC DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-17
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


Changed on 8/31/2010

VAERS ID: 105197 Before After
VAERS Form:
Age:67.5
Sex:Male
Location:Kentucky
Vaccinated:1997-10-23
Onset:1997-11-17
Submitted:1997-11-18
Entered:1997-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 97-98) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4978145 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-17
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


Changed on 7/7/2013

VAERS ID: 105197 Before After
VAERS Form:
Age:67.5
Sex:Male
Location:Kentucky
Vaccinated:1997-10-23
Onset:1997-11-17
Submitted:1997-11-18
Entered:1997-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 3 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-17
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


Changed on 2/14/2017

VAERS ID: 105197 Before After
VAERS Form:
Age:67.5 67.0
Sex:Male
Location:Kentucky
Vaccinated:1997-10-23
Onset:1997-11-17
Submitted:1997-11-18
Entered:1997-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-17
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


Changed on 5/14/2017

VAERS ID: 105197 Before After
VAERS Form:
Age:67.0
Sex:Male
Location:Kentucky
Vaccinated:1997-10-23
Onset:1997-11-17
Submitted:1997-11-18
Entered:1997-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


Changed on 9/14/2017

VAERS ID: 105197 Before After
VAERS Form:(blank) 1
Age:67.0
Sex:Male
Location:Kentucky
Vaccinated:1997-10-23
Onset:1997-11-17
Submitted:1997-11-18
Entered:1997-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 3 4 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


Changed on 2/14/2018

VAERS ID: 105197 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Kentucky
Vaccinated:1997-10-23
Onset:1997-11-17
Submitted:1997-11-18
Entered:1997-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 4 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


Changed on 6/14/2018

VAERS ID: 105197 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Kentucky
Vaccinated:1997-10-23
Onset:1997-11-17
Submitted:1997-11-18
Entered:1997-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 4 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


Changed on 8/14/2018

VAERS ID: 105197 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Kentucky
Vaccinated:1997-10-23
Onset:1997-11-17
Submitted:1997-11-18
Entered:1997-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 4 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


Changed on 9/14/2018

VAERS ID: 105197 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Kentucky
Vaccinated:1997-10-23
Onset:1997-11-17
Submitted:1997-11-18
Entered:1997-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 4 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;


Changed on 10/14/2018

VAERS ID: 105197 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Kentucky
Vaccinated:1997-10-23
Onset:1997-11-17
Submitted:1997-11-18
Entered:1997-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978145 / 4 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found slumped in chair early morning of 17NOV97;they think pt had a heart attack according to wife;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=105197&WAYBACKHISTORY=ON


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