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This is VAERS ID 110547

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 110547
VAERS Form:
Age:74.0
Sex:Male
Location:Michigan
Vaccinated:1998-04-07
Onset:1998-04-07
Submitted:1998-04-08
Entered:1998-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED, ADULTS / CONNAUGHT LABS 0923910 / 2 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: APNEA, HEART ARREST, FIBRILLAT VENT, COMA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-07
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: Azulfidine, HCTZ, Cardizem, Synthroid;
Current Illness: NONE
Preexisting Conditions: ulcerative colitis, asthma, CAD;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (null)


Changed on 12/8/2009

VAERS ID: 110547 Before After
VAERS Form:
Age:74.0
Sex:Male
Location:Michigan
Vaccinated:1998-04-07
Onset:1998-04-07
Submitted:1998-04-08
Entered:1998-05-06 1998-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED, ADULTS TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0923910 / 2 LA / IM

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Coma, Syncope, Ventricular fibrillation, APNEA, HEART ARREST, FIBRILLAT VENT, COMA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-07
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: Azulfidine, HCTZ, Cardizem, Synthroid;
Current Illness: NONE
Preexisting Conditions: ulcerative colitis, asthma, CAD;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (null)


Changed on 5/14/2017

VAERS ID: 110547 Before After
VAERS Form:
Age:74.0
Sex:Male
Location:Michigan
Vaccinated:1998-04-07
Onset:1998-04-07
Submitted:1998-04-08
Entered:1998-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0923910 / 2 LA / IM

Administered by: Unknown Private      Purchased by: Unknown Private
Symptoms: Apnoea, Cardiac arrest, Coma, Syncope, Ventricular fibrillation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-07
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: Azulfidine, HCTZ, Cardizem, Synthroid;
Current Illness: NONE
Preexisting Conditions: ulcerative colitis, asthma, CAD;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (null). The medical records state loss of consciousness and ventricular fibrillation.


Changed on 9/14/2017

VAERS ID: 110547 Before After
VAERS Form:(blank) 1
Age:74.0
Sex:Male
Location:Michigan
Vaccinated:1998-04-07
Onset:1998-04-07
Submitted:1998-04-08
Entered:1998-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0923910 / 2 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Syncope, Ventricular fibrillation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-07
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: Azulfidine, HCTZ, Cardizem, Synthroid;
Current Illness: NONE
Preexisting Conditions: ulcerative colitis, asthma, CAD;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (null). The medical records state loss of consciousness and ventricular fibrillation.


Changed on 2/14/2018

VAERS ID: 110547 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Michigan
Vaccinated:1998-04-07
Onset:1998-04-07
Submitted:1998-04-08
Entered:1998-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0923910 / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Syncope, Ventricular fibrillation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-07
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: Azulfidine, HCTZ, Cardizem, Synthroid;
Current Illness: NONE
Preexisting Conditions: ulcerative colitis, asthma, CAD;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (null). The medical records state loss of consciousness and ventricular fibrillation.


Changed on 6/14/2018

VAERS ID: 110547 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Michigan
Vaccinated:1998-04-07
Onset:1998-04-07
Submitted:1998-04-08
Entered:1998-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0923910 / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Syncope, Ventricular fibrillation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-07
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: Azulfidine, HCTZ, Cardizem, Synthroid;
Current Illness: NONE
Preexisting Conditions: ulcerative colitis, asthma, CAD;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (null). The medical records state loss of consciousness and ventricular fibrillation.


Changed on 8/14/2018

VAERS ID: 110547 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Michigan
Vaccinated:1998-04-07
Onset:1998-04-07
Submitted:1998-04-08
Entered:1998-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0923910 / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Syncope, Ventricular fibrillation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-07
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: Azulfidine, HCTZ, Cardizem, Synthroid;
Current Illness: NONE
Preexisting Conditions: ulcerative colitis, asthma, CAD;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (null). The medical records state loss of consciousness and ventricular fibrillation.


Changed on 9/14/2018

VAERS ID: 110547 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Michigan
Vaccinated:1998-04-07
Onset:1998-04-07
Submitted:1998-04-08
Entered:1998-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0923910 / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Syncope, Ventricular fibrillation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-07
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: Azulfidine, HCTZ, Cardizem, Synthroid;
Current Illness: NONE
Preexisting Conditions: ulcerative colitis, asthma, CAD;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (null). The medical records state loss of consciousness and ventricular fibrillation.


Changed on 10/14/2018

VAERS ID: 110547 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Michigan
Vaccinated:1998-04-07
Onset:1998-04-07
Submitted:1998-04-08
Entered:1998-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0923910 / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Syncope, Ventricular fibrillation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-07
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: Azulfidine, HCTZ, Cardizem, Synthroid;
Current Illness: NONE
Preexisting Conditions: ulcerative colitis, asthma, CAD;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (null). The medical records state loss of consciousness and ventricular fibrillation.

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