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This is VAERS ID 115260

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 115260
VAERS Form:
Age:77.3
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1998-1999 / CONNAUGHT LABS 0975790 / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: FEVER, MALAISE

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 12/8/2009

VAERS ID: 115260 Before After
VAERS Form:
Age:77.3
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-27 1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1998-1999 INFLUENZA (SEASONAL) (FLUZONE 98-99) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0975790 / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Malaise, Pyrexia, FEVER, MALAISE

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 8/31/2010

VAERS ID: 115260 Before After
VAERS Form:
Age:77.3
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 98-99) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 7/7/2013

VAERS ID: 115260 Before After
VAERS Form:
Age:77.3
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 2/14/2017

VAERS ID: 115260 Before After
VAERS Form:
Age:77.3 77.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 5/14/2017

VAERS ID: 115260 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 9/14/2017

VAERS ID: 115260 Before After
VAERS Form:(blank) 1
Age:77.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 2/14/2018

VAERS ID: 115260 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 6/14/2018

VAERS ID: 115260 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 8/14/2018

VAERS ID: 115260 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 9/14/2018

VAERS ID: 115260 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 10/14/2018

VAERS ID: 115260 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 12/24/2020

VAERS ID: 115260 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

Changed on 12/30/2020

VAERS ID: 115260 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-10-21
Onset:1998-10-22
Submitted:1998-10-23
Entered:1998-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0975790 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-22
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, HTN
Allergies:
Diagnostic Lab Data: T102.4;
CDC 'Split Type':

Write-up: c/o vague sx of not feeling well;T102.4;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=115260&WAYBACKHISTORY=ON


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