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This is VAERS ID 105293

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 105293
VAERS Form:
Age:78.9
Sex:Female
Location:Oregon
Vaccinated:1996-11-12
Onset:1996-11-12
Submitted:1997-11-24
Entered:1997-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1996-1997 / CONNAUGHT LABS 6F71238 / 0 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: death


Changed on 12/8/2009

VAERS ID: 105293 Before After
VAERS Form:
Age:78.9
Sex:Female
Location:Oregon
Vaccinated:1996-11-12
Onset:1996-11-12
Submitted:1997-11-24
Entered:1997-12-03 1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1996-1997 INFLUENZA (SEASONAL) (FLUZONE 96-97) / CONNAUGHT LABS CONNAUGHT LABORATORIES 6F71238 / 0 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE (blank)

Write-up: death


Changed on 8/31/2010

VAERS ID: 105293 Before After
VAERS Form:
Age:78.9
Sex:Female
Location:Oregon
Vaccinated:1996-11-12
Onset:1996-11-12
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 96-97) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 0 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death


Changed on 7/7/2013

VAERS ID: 105293 Before After
VAERS Form:
Age:78.9
Sex:Female
Location:Oregon
Vaccinated:1996-11-12
Onset:1996-11-12
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 0 LA / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 0 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death


Changed on 2/14/2017

VAERS ID: 105293 Before After
VAERS Form:
Age:78.9 78.0
Sex:Female
Location:Oregon
Vaccinated:1996-11-12
Onset:1996-11-12
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 0 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death


Changed on 5/14/2017

VAERS ID: 105293 Before After
VAERS Form:
Age:78.0
Sex:Female
Location:Oregon
Vaccinated:1996-11-12
Onset:1996-11-12
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 0 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death


Changed on 9/14/2017

VAERS ID: 105293 Before After
VAERS Form:(blank) 1
Age:78.0
Sex:Female
Location:Oregon
Vaccinated:1996-11-12
Onset:1996-11-12
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 0 1 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death


Changed on 2/14/2018

VAERS ID: 105293 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Oregon
Vaccinated:1996-11-12
Onset:1996-11-12
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 1 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death


Changed on 6/14/2018

VAERS ID: 105293 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Oregon
Vaccinated:1996-11-12
Onset:1996-11-12
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 1 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death


Changed on 8/14/2018

VAERS ID: 105293 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Oregon
Vaccinated:1996-11-12
Onset:1996-11-12
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 1 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death


Changed on 9/14/2018

VAERS ID: 105293 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Oregon
Vaccinated:1996-11-12
Onset:1996-11-12
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 1 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death


Changed on 10/14/2018

VAERS ID: 105293 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Oregon
Vaccinated:1996-11-12
Onset:1996-11-12
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71238 / 1 LA / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=105293&WAYBACKHISTORY=ON


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