National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 161416

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 161416
VAERS Form:
Age:79.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-11-02
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU:   /   - / - - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-16
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC 'Split Type':

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/0"0. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00


Changed on 12/30/2006

VAERS ID: 161416 Before After
VAERS Form:
Age:79.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-11-02
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU:   /   - / - - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-16
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC 'Split Type':

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 ''''00-''''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/0"0. 10/15"/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00 10/16/0


Changed on 12/8/2009

VAERS ID: 161416 Before After
VAERS Form:
Age:79.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-11-02
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU:   INFLUENZA (SEASONAL) (FLUZONE 00-01) /   AVENTIS PASTEUR - / - - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-16
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC 'Split Type': (blank) U2000007672

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''''00-''''01 ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15"/00. 10/15/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/0 10/16/00 not on 10/15/00 as previously reported. Additional pt and responsible physician information were also provided.


Changed on 8/31/2010

VAERS ID: 161416 Before After
VAERS Form:
Age:79.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-11-02
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 00-01) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / - - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-16
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC 'Split Type': U2000007672

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00 not on 10/15/00 as previously reported. Additional pt and responsible physician information were also provided.


Changed on 7/7/2013

VAERS ID: 161416 Before After
VAERS Form:
Age:79.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-11-02
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / - - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-16
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC 'Split Type': U2000007672

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00 not on 10/15/00 as previously reported. Additional pt and responsible physician information were also provided.


Changed on 2/14/2017

VAERS ID: 161416 Before After
VAERS Form:
Age:79.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-11-02
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / - - / IM

Administered by: Other      Purchased by: (blank) Unknown
Symptoms: Apnoea, Cardiac failure congestive, Chest X-ray abnormal, Respiratory distress

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-16
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC 'Split Type': U2000007672

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00 not on 10/15/00 as previously reported. Additional pt and responsible physician information were also provided.


Changed on 9/14/2017

VAERS ID: 161416 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-11-02
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / - UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-16
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC 'Split Type': U2000007672

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00 not on 10/15/00 as previously reported. Additional pt and responsible physician information were also provided.


Changed on 2/14/2018

VAERS ID: 161416 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-11-02
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-16
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC 'Split Type': U2000007672

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00 not on 10/15/00 as previously reported. Additional pt and responsible physician information were also provided.


Changed on 6/14/2018

VAERS ID: 161416 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-11-02
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-16
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC 'Split Type': U2000007672

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00 not on 10/15/00 as previously reported. Additional pt and responsible physician information were also provided.


Changed on 8/14/2018

VAERS ID: 161416 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-11-02
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-16
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC 'Split Type': U2000007672

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00 not on 10/15/00 as previously reported. Additional pt and responsible physician information were also provided.


Changed on 9/14/2018

VAERS ID: 161416 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-11-02
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-16
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC 'Split Type': U2000007672

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00 not on 10/15/00 as previously reported. Additional pt and responsible physician information were also provided.


Changed on 10/14/2018

VAERS ID: 161416 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Illinois
Vaccinated:2000-10-10
Onset:2000-10-15
Submitted:2000-11-02
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-16
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF; pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest X-ray-interstitial infiltrates noted.
CDC 'Split Type': U2000007672

Write-up: It was reported that a 79 year old male pt received a Fluzone SV ''00-''01 vaccination on 10/10/00. Reportedly, the pt developed respiratory distress and congestive heart failure. The pt was hospitalized in ICU on a ventilator and cease to breath on 10/15/00. Interstitial infiltrates notes on chest X-ray by Pulmonologist. Follow-up from 10/24/00, upon further evaluation is was discovered that the pt died on 10/15/00. Follow-up correspondence received on 11/2/00, it was reported that the pt died on 10/16/00 not on 10/15/00 as previously reported. Additional pt and responsible physician information were also provided.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=161416&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166