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This is VAERS ID 161041

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 161041
VAERS Form:
Age:82.0
Sex:Female
Location:Ohio
Vaccinated:2000-10-19
Onset:2000-10-20
Submitted:2000-10-23
Entered:2000-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU:   /   U0335AB / 1 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-20
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: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00.


Changed on 12/8/2009

VAERS ID: 161041 Before After
VAERS Form:
Age:82.0
Sex:Female
Location:Ohio
Vaccinated:2000-10-19
Onset:2000-10-20
Submitted:2000-10-23
Entered:2000-11-14 2000-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU:   INFLUENZA (SEASONAL) (FLUZONE 00-01) /   AVENTIS PASTEUR U0335AB / 1 LA / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-20
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: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00. 5


Changed on 8/31/2010

VAERS ID: 161041 Before After
VAERS Form:
Age:82.0
Sex:Female
Location:Ohio
Vaccinated:2000-10-19
Onset:2000-10-20
Submitted:2000-10-23
Entered:2000-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 00-01) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-20
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: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00. 5


Changed on 7/7/2013

VAERS ID: 161041 Before After
VAERS Form:
Age:82.0
Sex:Female
Location:Ohio
Vaccinated:2000-10-19
Onset:2000-10-20
Submitted:2000-10-23
Entered:2000-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 1 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-20
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: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00. 5


Changed on 5/14/2017

VAERS ID: 161041 Before After
VAERS Form:
Age:82.0
Sex:Female
Location:Ohio
Vaccinated:2000-10-19
Onset:2000-10-20
Submitted:2000-10-23
Entered:2000-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-20
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: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00. 5


Changed on 9/14/2017

VAERS ID: 161041 Before After
VAERS Form:(blank) 1
Age:82.0
Sex:Female
Location:Ohio
Vaccinated:2000-10-19
Onset:2000-10-20
Submitted:2000-10-23
Entered:2000-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 1 2 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-20
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: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00.


Changed on 2/14/2018

VAERS ID: 161041 Before After
VAERS Form:1
Age:82.0
Sex:Female
Location:Ohio
Vaccinated:2000-10-19
Onset:2000-10-20
Submitted:2000-10-23
Entered:2000-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 2 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-20
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: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00.


Changed on 6/14/2018

VAERS ID: 161041 Before After
VAERS Form:1
Age:82.0
Sex:Female
Location:Ohio
Vaccinated:2000-10-19
Onset:2000-10-20
Submitted:2000-10-23
Entered:2000-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 2 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-20
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: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00.


Changed on 8/14/2018

VAERS ID: 161041 Before After
VAERS Form:1
Age:82.0
Sex:Female
Location:Ohio
Vaccinated:2000-10-19
Onset:2000-10-20
Submitted:2000-10-23
Entered:2000-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 2 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-20
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: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00.


Changed on 9/14/2018

VAERS ID: 161041 Before After
VAERS Form:1
Age:82.0
Sex:Female
Location:Ohio
Vaccinated:2000-10-19
Onset:2000-10-20
Submitted:2000-10-23
Entered:2000-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 2 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-20
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: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00.


Changed on 10/14/2018

VAERS ID: 161041 Before After
VAERS Form:1
Age:82.0
Sex:Female
Location:Ohio
Vaccinated:2000-10-19
Onset:2000-10-20
Submitted:2000-10-23
Entered:2000-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U0335AB / 2 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-20
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: CAD, DM, HTN, MI, CVA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt received flu vax on 10/19/00. She expired in her sleep on 10/20/00.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=161041&WAYBACKHISTORY=ON


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