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This is VAERS ID 105745

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 105745
VAERS Form:
Age:77.4
Sex:Male
Location:Maryland
Vaccinated:1997-11-21
Onset:1997-11-22
Submitted:1997-12-11
Entered:1997-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1997-1998 / MEDEVA PHARMS LI E20017HA / 0 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-22
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: NA
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC 'Split Type': unk

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


Changed on 12/8/2009

VAERS ID: 105745 Before After
VAERS Form:
Age:77.4
Sex:Male
Location:Maryland
Vaccinated:1997-11-21
Onset:1997-11-22
Submitted:1997-12-11
Entered:1997-12-18 1997-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1997-1998 INFLUENZA (SEASONAL) (FLUVIRIN 97-98) / MEDEVA PHARMS LI MEDEVA PHARMA, LTD. E20017HA / 0 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-22
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: NA
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC 'Split Type': unk MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


Changed on 8/31/2010

VAERS ID: 105745 Before After
VAERS Form:
Age:77.4
Sex:Male
Location:Maryland
Vaccinated:1997-11-21
Onset:1997-11-22
Submitted:1997-12-11
Entered:1997-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN 97-98) INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-22
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: NA
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC 'Split Type': MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


Changed on 7/7/2013

VAERS ID: 105745 Before After
VAERS Form:
Age:77.4
Sex:Male
Location:Maryland
Vaccinated:1997-11-21
Onset:1997-11-22
Submitted:1997-12-11
Entered:1997-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 0 LA / -
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-22
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: NA
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC 'Split Type': MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


Changed on 2/14/2017

VAERS ID: 105745 Before After
VAERS Form:
Age:77.4 77.0
Sex:Male
Location:Maryland
Vaccinated:1997-11-21
Onset:1997-11-22
Submitted:1997-12-11
Entered:1997-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-22
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: NA
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC 'Split Type': MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


Changed on 5/14/2017

VAERS ID: 105745 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1997-11-21
Onset:1997-11-22
Submitted:1997-12-11
Entered:1997-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-22
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: NA NA~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC 'Split Type': MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


Changed on 9/14/2017

VAERS ID: 105745 Before After
VAERS Form:(blank) 1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1997-11-21
Onset:1997-11-22
Submitted:1997-12-11
Entered:1997-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 0 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-22
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: NA~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC 'Split Type': MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


Changed on 2/14/2018

VAERS ID: 105745 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1997-11-21
Onset:1997-11-22
Submitted:1997-12-11
Entered:1997-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-22
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: NA~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC 'Split Type': MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


Changed on 6/14/2018

VAERS ID: 105745 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1997-11-21
Onset:1997-11-22
Submitted:1997-12-11
Entered:1997-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-22
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: NA~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC 'Split Type': MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


Changed on 8/14/2018

VAERS ID: 105745 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1997-11-21
Onset:1997-11-22
Submitted:1997-12-11
Entered:1997-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-22
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: NA~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC 'Split Type': MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


Changed on 9/14/2018

VAERS ID: 105745 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1997-11-21
Onset:1997-11-22
Submitted:1997-12-11
Entered:1997-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-22
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: NA~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC 'Split Type': MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;


Changed on 10/14/2018

VAERS ID: 105745 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1997-11-21
Onset:1997-11-22
Submitted:1997-12-11
Entered:1997-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20017HA / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-22
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: NA~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: medical examiners case
CDC 'Split Type': MD97020

Write-up: son was retrieving late fathers personal effects & found flu vax recv, noting date given was w/in 24hr of father''s death;stated wanted us to be aware in case this was part of a larger problem;father lived alone;

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=105745&WAYBACKHISTORY=ON


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