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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 115054 |
VAERS Form: | |
Age: | 83.0 |
Sex: | Male |
Location: | Massachusetts |
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-20 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: FLUZONE 1998-1999 / CONNAUGHT LABS | 0975790 / - | A / IM |
Administered by: Public Purchased by: Unknown
Symptoms: REACT UNEVAL
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-20 1998-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: FLUZONE 1998-1999 INFLUENZA (SEASONAL) (FLUZONE 98-99) / CONNAUGHT LABS CONNAUGHT LABORATORIES | 0975790 / - | A / IM |
Administered by: Public Purchased by: Unknown Public
Symptoms: Unevaluable event, REACT UNEVAL
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) U199800624
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: INFLUENZA (SEASONAL) (FLUZONE 98-99) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES | 0975790 / - | A / IM |
Administered by: Public Purchased by: Public
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800624
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES | 0975790 / - | A / IM |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES | 0975790 / - | A / IM |
Administered by: Public Purchased by: Public
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800624
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES | 0975790 / - | A - / IM IM A |
Administered by: Public Purchased by: Public
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800624
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES | 0975790 / - UNK | - / IM A |
Administered by: Public Purchased by: Public
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800624
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES | 0975790 / UNK | - / IM A |
Administered by: Public Purchased by: Public
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800624
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES | 0975790 / UNK | - / IM A |
Administered by: Public Purchased by: Public
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800624
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES | 0975790 / UNK | - / IM A |
Administered by: Public Purchased by: Public
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800624
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES | 0975790 / UNK | - / IM A |
Administered by: Public Purchased by: Public
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800624
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES | 0975790 / UNK | - / IM A |
Administered by: Public Purchased by: Public
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800624
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES | 0975790 / UNK | - / IM A |
Administered by: Public Purchased by: Public
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800624
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Vaccinated: | 1998-10-08 |
Onset: | 1998-10-08 |
Submitted: | 1998-10-14 |
Entered: | 1998-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES | 0975790 / UNK | - / IM A |
Administered by: Public Purchased by: Public
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-10-08
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: unk
Preexisting Conditions: NKDA or other allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800624
Write-up: pt recv vax & approx 30min post vax pt collapsed @ home brought to hosp & pronounced DOA;
Link To This Search Result:
https://medalerts.org/vaersdb/findfield.php?IDNUMBER=115054&WAYBACKHISTORY=ON
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