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This is VAERS ID 160872

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 160872
VAERS Form:
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-01
Onset:0000-00-00
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU:   / MEDEVA PHARMS LI E66340HA / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: STUPOR, APNEA, DYSPNEA, HEART ARREST, EMB PULM

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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for app"roximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with ""no sinus rhythm"" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives,


Changed on 12/30/2006

VAERS ID: 160872 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-01
Onset:0000-00-00
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU:   / MEDEVA PHARMS LI E66340HA / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: STUPOR, APNEA, DYSPNEA, HEART ARREST, EMB PULM

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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s pt''''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for app"roximately ap"proximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with ""no /"no sinus rhythm"" rhythm/" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, hives


Changed on 12/8/2009

VAERS ID: 160872 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-01 2000-10-09
Onset:0000-00-00 2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU:   INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMS LI EVANS VACCINES E66340HA / - - / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring, STUPOR, APNEA, DYSPNEA, HEART ARREST, EMB PULM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00 2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''''s pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for ap"proximately approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with /"no "no sinus rhythm/" rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothy


Changed on 8/31/2010

VAERS ID: 160872 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-09
Onset:2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothy


Changed on 4/13/2011

VAERS ID: 160872 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-09
Onset:2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothy


Changed on 5/13/2011

VAERS ID: 160872 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-09
Onset:2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothy


Changed on 6/11/2011

VAERS ID: 160872 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-09
Onset:2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothy


Changed on 7/7/2013

VAERS ID: 160872 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-09
Onset:2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothy


Changed on 5/14/2017

VAERS ID: 160872 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-09
Onset:2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothy hypothyroidism, and allergies to penicillin, rvp dye, shellfish, and Tegretol.


Changed on 9/14/2017

VAERS ID: 160872 Before After
VAERS Form:(blank) 1
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-09
Onset:2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / - UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothyroidism, and allergies to penicillin, rvp dye, shellfish, and Tegretol.


Changed on 2/14/2018

VAERS ID: 160872 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-09
Onset:2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothyroidism, and allergies to penicillin, rvp dye, shellfish, and Tegretol.


Changed on 6/14/2018

VAERS ID: 160872 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-09
Onset:2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothyroidism, and allergies to penicillin, rvp dye, shellfish, and Tegretol.


Changed on 8/14/2018

VAERS ID: 160872 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-09
Onset:2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothyroidism, and allergies to penicillin, rvp dye, shellfish, and Tegretol.


Changed on 9/14/2018

VAERS ID: 160872 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-09
Onset:2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothyroidism, and allergies to penicillin, rvp dye, shellfish, and Tegretol.


Changed on 10/14/2018

VAERS ID: 160872 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:New Mexico
Vaccinated:2000-10-09
Onset:2000-10-09
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / EVANS VACCINES E66340HA / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Dyspnoea, Pulmonary embolism, Respiratory arrest, Sinus arrest, Staring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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: unspecified inhaler
Current Illness:
Preexisting Conditions: obesity, diabetes, diabetic neuropathies, transverse myelitis, neurogenic bladder control, asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI2000047920

Write-up: The evening of the vax, the pt complained of shortness of breath and requested use of inhaler. The pt''s husband noted little or no relief. The pt was then transferred to bed from her motorized cart. the husband observed her to stare at the ceiling for approximately 20 seconds. She became frightened and asked him to get help. A neighbor (who happens to be a Pulmonologist) was called. He found the pt with "no sinus rhythm" and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Additional information has been requested. Follow up report received 11/07/2000: One of 2 spontaneous reports received from a physician, regarding possible adverse events associated with uses of Fluvirin, lot # H66340HA. A 55 year old morbidly obese female (weight $g 350 pounds), with a history of diabetes with diabetic neuropathics, possible transverse myelitis (recent development of neurogenic bladder control problems), and mild asthma, (requiring recent increased use of her inhalers), received vaccination with Fluvirin in October 2000. Later that evening, patient complained of shortness of breath and requested use of inhaler. Husband noted little or no relief. Patient was then transferred to bed, from her motorized cart. Husband observed her to stare at the ceiling for approximately 20 seconds. She becaem frightened and asked him to get help. A neighor (who happens to be a Pulmonologist) was called. He found patient with no sinus rhythm and was unable to resuscitate her. There was no evidence of bronchospasm, no hives, and no report of audible wheezing. The death certificate lists "Pulmonary arrest" as cause of death. Reporting MD and Pulmonologist suspect pulmonary embolus as exact cause of death. Follow up information received, November 1, 2000 from the primary care physician. Medical history significant for hypothyroidism, and allergies to penicillin, rvp dye, shellfish, and Tegretol.

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