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This is VAERS ID 160801

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 160801
VAERS Form:
Age:87.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-10-20
Entered:2000-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU:   /   - / - - / IM

Administered by: ??      Purchased by: Unknown
Symptoms: DYSPNEA, LUNG DIS, HEART FAIL (NOT HEAR

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest x-ray - interstitial infiltrates
CDC 'Split Type':

Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.


Changed on 12/8/2009

VAERS ID: 160801 Before After
VAERS Form:
Age:87.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-10-20
Entered:2000-10-24 2000-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU:   INFLUENZA (SEASONAL) (FLUZONE 00-01) /   AVENTIS PASTEUR - / - - / IM

Administered by: (blank) Unknown      Purchased by: Unknown
Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress, DYSPNEA, LUNG DIS, HEART FAIL (NOT HEAR

Life Threatening? No
Birth Defect? No
Died? No Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest x-ray - interstitial infiltrates
CDC 'Split Type': (blank) U200007670

Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.


Changed on 8/31/2010

VAERS ID: 160801 Before After
VAERS Form:
Age:87.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-10-20
Entered:2000-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 00-01) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest x-ray - interstitial infiltrates
CDC 'Split Type': U200007670

Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.


Changed on 7/7/2013

VAERS ID: 160801 Before After
VAERS Form:
Age:87.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-10-20
Entered:2000-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest x-ray - interstitial infiltrates
CDC 'Split Type': U200007670

Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.


Changed on 5/14/2017

VAERS ID: 160801 Before After
VAERS Form:
Age:87.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-10-20
Entered:2000-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest x-ray - interstitial infiltrates
CDC 'Split Type': U200007670 U2000007670

Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.


Changed on 9/14/2017

VAERS ID: 160801 Before After
VAERS Form:(blank) 1
Age:87.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-10-20
Entered:2000-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest x-ray - interstitial infiltrates
CDC 'Split Type': U2000007670

Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.


Changed on 2/14/2018

VAERS ID: 160801 Before After
VAERS Form:1
Age:87.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-10-20
Entered:2000-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest x-ray - interstitial infiltrates
CDC 'Split Type': U2000007670

Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.


Changed on 6/14/2018

VAERS ID: 160801 Before After
VAERS Form:1
Age:87.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-10-20
Entered:2000-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest x-ray - interstitial infiltrates
CDC 'Split Type': U2000007670

Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.


Changed on 8/14/2018

VAERS ID: 160801 Before After
VAERS Form:1
Age:87.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-10-20
Entered:2000-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest x-ray - interstitial infiltrates
CDC 'Split Type': U2000007670

Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.


Changed on 9/14/2018

VAERS ID: 160801 Before After
VAERS Form:1
Age:87.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-10-20
Entered:2000-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest x-ray - interstitial infiltrates
CDC 'Split Type': U2000007670

Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.


Changed on 10/14/2018

VAERS ID: 160801 Before After
VAERS Form:1
Age:87.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-10-20
Entered:2000-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: chest x-ray - interstitial infiltrates
CDC 'Split Type': U2000007670

Write-up: The pt experienced respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and CTB on 10/15/00. Interstitial infiltrates noted on chest x-ray by Pulmonologist.

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