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This is VAERS ID 107361

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 107361
VAERS Form:
Age:40.2
Sex:Male
Location:Louisiana
Vaccinated:1996-10-31
Onset:1996-11-05
Submitted:1998-01-26
Entered:1998-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1996-1997 / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: COMA, DIABETES MELL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type':

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


Changed on 12/8/2009

VAERS ID: 107361 Before After
VAERS Form:
Age:40.2
Sex:Male
Location:Louisiana
Vaccinated:1996-10-31
Onset:1996-11-05
Submitted:1998-01-26
Entered:1998-02-11 1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1996-1997 INFLUENZA (SEASONAL) (FLUOGEN 96-97) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Coma, Diabetes mellitus, COMA, DIABETES MELL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': (blank) 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


Changed on 8/31/2010

VAERS ID: 107361 Before After
VAERS Form:
Age:40.2
Sex:Male
Location:Louisiana
Vaccinated:1996-10-31
Onset:1996-11-05
Submitted:1998-01-26
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 96-97) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Coma, Diabetes mellitus

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


Changed on 7/7/2013

VAERS ID: 107361 Before After
VAERS Form:
Age:40.2
Sex:Male
Location:Louisiana
Vaccinated:1996-10-31
Onset:1996-11-05
Submitted:1998-01-26
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Coma, Diabetes mellitus

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


Changed on 2/14/2017

VAERS ID: 107361 Before After
VAERS Form:
Age:40.2 40.0
Sex:Male
Location:Louisiana
Vaccinated:1996-10-31
Onset:1996-11-05
Submitted:1998-01-26
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Coma, Diabetes mellitus

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


Changed on 5/14/2017

VAERS ID: 107361 Before After
VAERS Form:
Age:40.0
Sex:Male
Location:Louisiana
Vaccinated:1996-10-31
Onset:1996-11-05
Submitted:1998-01-26
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Coma, Diabetes mellitus

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


Changed on 9/14/2017

VAERS ID: 107361 Before After
VAERS Form:(blank) 1
Age:40.0
Sex:Male
Location:Louisiana
Vaccinated:1996-10-31
Onset:1996-11-05
Submitted:1998-01-26
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Coma, Diabetes mellitus

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


Changed on 2/14/2018

VAERS ID: 107361 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:Louisiana
Vaccinated:1996-10-31
Onset:1996-11-05
Submitted:1998-01-26
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Coma, Diabetes mellitus

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


Changed on 6/14/2018

VAERS ID: 107361 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:Louisiana
Vaccinated:1996-10-31
Onset:1996-11-05
Submitted:1998-01-26
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Coma, Diabetes mellitus

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


Changed on 8/14/2018

VAERS ID: 107361 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:Louisiana
Vaccinated:1996-10-31
Onset:1996-11-05
Submitted:1998-01-26
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Coma, Diabetes mellitus

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


Changed on 9/14/2018

VAERS ID: 107361 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:Louisiana
Vaccinated:1996-10-31
Onset:1996-11-05
Submitted:1998-01-26
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Coma, Diabetes mellitus

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;


Changed on 10/14/2018

VAERS ID: 107361 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:Louisiana
Vaccinated:1996-10-31
Onset:1996-11-05
Submitted:1998-01-26
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Coma, Diabetes mellitus

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: unk
Current Illness:
Preexisting Conditions: no hx of diabetes
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': 0010150980002

Write-up: pt recv vax 31OCT96 & exp diabetic coma on 5NOV96 & died that day;pt had no hx of diabetes;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=107361&WAYBACKHISTORY=ON


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