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This is VAERS ID 115514

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 115514
VAERS Form:
Age:86.1
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1998-1999 / MEDEVA PHARMS LI E20158HG / 5 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: CARDIOVASC DIS, ARTERIOSCLEROSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 12/8/2009

VAERS ID: 115514 Before After
VAERS Form:
Age:86.1
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-03 1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1998-1999 INFLUENZA (SEASONAL) (FLUVIRIN 98-99) / MEDEVA PHARMS LI MEDEVA PHARMA, LTD. E20158HG / 5 LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Arteriosclerosis, Cardiovascular disorder, CARDIOVASC DIS, ARTERIOSCLEROSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 8/31/2010

VAERS ID: 115514 Before After
VAERS Form:
Age:86.1
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN 98-99) INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 5 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 7/7/2013

VAERS ID: 115514 Before After
VAERS Form:
Age:86.1
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 5 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 5 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 2/14/2017

VAERS ID: 115514 Before After
VAERS Form:
Age:86.1 86.0
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 5 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 5/14/2017

VAERS ID: 115514 Before After
VAERS Form:
Age:86.0
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 5 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 9/14/2017

VAERS ID: 115514 Before After
VAERS Form:(blank) 1
Age:86.0
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 5 6 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 2/14/2018

VAERS ID: 115514 Before After
VAERS Form:1
Age:86.0
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 6 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 6/14/2018

VAERS ID: 115514 Before After
VAERS Form:1
Age:86.0
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 6 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 8/14/2018

VAERS ID: 115514 Before After
VAERS Form:1
Age:86.0
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 6 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 9/14/2018

VAERS ID: 115514 Before After
VAERS Form:1
Age:86.0
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 6 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 10/14/2018

VAERS ID: 115514 Before After
VAERS Form:1
Age:86.0
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 6 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 12/24/2020

VAERS ID: 115514 Before After
VAERS Form:1
Age:86.0
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 6 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;


Changed on 12/30/2020

VAERS ID: 115514 Before After
VAERS Form:1
Age:86.0
Sex:Female
Location:Mississippi
Vaccinated:1998-10-19
Onset:1998-10-19
Submitted:1998-10-21
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20158HG / 6 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Cardiovascular disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-10-19
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:
Current Illness: when asked if sick of feeling bad;pt did not report any problems
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS98022

Write-up: pt recv vax approx 830AM & pt pronounced dead on front steps of home;between 1:00 & 2PM 19OCT98 by medical examiner;

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=115514&WAYBACKHISTORY=ON


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