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This is VAERS ID 115910

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 115910
VAERS Form:
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1998-1999 / CONNAUGHT LABS 0981790 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


Changed on 12/8/2009

VAERS ID: 115910 Before After
VAERS Form:
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-10 1998-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1998-1999 INFLUENZA (SEASONAL) (FLUZONE 98-99) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0981790 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


Changed on 8/31/2010

VAERS ID: 115910 Before After
VAERS Form:
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 98-99) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


Changed on 7/7/2013

VAERS ID: 115910 Before After
VAERS Form:
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


Changed on 5/14/2017

VAERS ID: 115910 Before After
VAERS Form:
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


Changed on 9/14/2017

VAERS ID: 115910 Before After
VAERS Form:(blank) 1
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


Changed on 2/14/2018

VAERS ID: 115910 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


Changed on 6/14/2018

VAERS ID: 115910 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


Changed on 8/14/2018

VAERS ID: 115910 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


Changed on 9/14/2018

VAERS ID: 115910 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


Changed on 10/14/2018

VAERS ID: 115910 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


Changed on 12/24/2020

VAERS ID: 115910 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;


Changed on 12/30/2020

VAERS ID: 115910 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Virginia
Vaccinated:1998-10-29
Onset:1998-10-29
Submitted:1998-11-04
Entered:1998-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0981790 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800766

Write-up: pt recv vax 29OCT98 & died post cardiac arrest;pt had no allergic or anaphylactic rxn immed to the vax;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=115910&WAYBACKHISTORY=ON


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