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This is VAERS ID 161790

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 161790
VAERS Form:
Age:94.0
Sex:Male
Location:Oklahoma
Vaccinated:2000-11-03
Onset:2000-11-08
Submitted:2000-11-10
Entered:2000-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU:   / WYETH 4008173 / 0 RA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: FEVER, DYSPNEA, ASTHMA, COUGH INC, NERVOUSNESS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2001-02-07
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: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower l"obes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received


Changed on 12/8/2009

VAERS ID: 161790 Before After
VAERS Form:
Age:94.0
Sex:Male
Location:Oklahoma
Vaccinated:2000-11-03
Onset:2000-11-08
Submitted:2000-11-10
Entered:2000-11-14 2000-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU:   INFLUENZA (SEASONAL) (FLUSHIELD 00-01) / WYETH WYETH PHARMACEUTICALS, INC 4008173 / 0 RA / IM

Administered by: Other      Purchased by: Unknown Public
Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing, FEVER, DYSPNEA, ASTHMA, COUGH INC, NERVOUSNESS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2001-02-07
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: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower l"obes. lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 s9 tes the pt passed away on 2/7/01. Cause of Death - pneumonia.


Changed on 8/31/2010

VAERS ID: 161790 Before After
VAERS Form:
Age:94.0
Sex:Male
Location:Oklahoma
Vaccinated:2000-11-03
Onset:2000-11-08
Submitted:2000-11-10
Entered:2000-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 00-01) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4008173 / 0 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2001-02-07
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: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 s9 tes the pt passed away on 2/7/01. Cause of Death - pneumonia.


Changed on 7/7/2013

VAERS ID: 161790 Before After
VAERS Form:
Age:94.0
Sex:Male
Location:Oklahoma
Vaccinated:2000-11-03
Onset:2000-11-08
Submitted:2000-11-10
Entered:2000-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008173 / 0 RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008173 / 0 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2001-02-07
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: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 s9 tes the pt passed away on 2/7/01. Cause of Death - pneumonia.


Changed on 5/14/2017

VAERS ID: 161790 Before After
VAERS Form:
Age:94.0
Sex:Male
Location:Oklahoma
Vaccinated:2000-11-03
Onset:2000-11-08
Submitted:2000-11-10
Entered:2000-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008173 / 0 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2001-02-07
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: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 s9 tes states the pt passed away on 2/7/01. Cause of Death - pneumonia.


Changed on 9/14/2017

VAERS ID: 161790 Before After
VAERS Form:(blank) 1
Age:94.0
Sex:Male
Location:Oklahoma
Vaccinated:2000-11-03
Onset:2000-11-08
Submitted:2000-11-10
Entered:2000-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008173 / 0 1 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2001-02-07
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: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 states the pt passed away on 2/7/01. Cause of Death - pneumonia.


Changed on 2/14/2018

VAERS ID: 161790 Before After
VAERS Form:1
Age:94.0
Sex:Male
Location:Oklahoma
Vaccinated:2000-11-03
Onset:2000-11-08
Submitted:2000-11-10
Entered:2000-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008173 / 1 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2001-02-07
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: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 states the pt passed away on 2/7/01. Cause of Death - pneumonia.


Changed on 6/14/2018

VAERS ID: 161790 Before After
VAERS Form:1
Age:94.0
Sex:Male
Location:Oklahoma
Vaccinated:2000-11-03
Onset:2000-11-08
Submitted:2000-11-10
Entered:2000-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008173 / 1 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2001-02-07
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: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 states the pt passed away on 2/7/01. Cause of Death - pneumonia.


Changed on 8/14/2018

VAERS ID: 161790 Before After
VAERS Form:1
Age:94.0
Sex:Male
Location:Oklahoma
Vaccinated:2000-11-03
Onset:2000-11-08
Submitted:2000-11-10
Entered:2000-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008173 / 1 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2001-02-07
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: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 states the pt passed away on 2/7/01. Cause of Death - pneumonia.


Changed on 9/14/2018

VAERS ID: 161790 Before After
VAERS Form:1
Age:94.0
Sex:Male
Location:Oklahoma
Vaccinated:2000-11-03
Onset:2000-11-08
Submitted:2000-11-10
Entered:2000-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008173 / 1 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2001-02-07
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: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 states the pt passed away on 2/7/01. Cause of Death - pneumonia.


Changed on 10/14/2018

VAERS ID: 161790 Before After
VAERS Form:1
Age:94.0
Sex:Male
Location:Oklahoma
Vaccinated:2000-11-03
Onset:2000-11-08
Submitted:2000-11-10
Entered:2000-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008173 / 1 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Cough, Pneumonia, Pyrexia, Respiratory distress, Restlessness, Wheezing

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2001-02-07
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: nitrofurantoin, Zantac, Ditropan, ibuprofen, Tylenol PM, cyanocobalamin (vit-B), Paxil, furosemide, prednisone
Current Illness: NONE
Preexisting Conditions: Senile dementia, UTI, dermatitis, depression, stomach function disease, pernicious anemia, neurogenic bladder, insomnia, pemphigoid
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 11/8/00 at 02:00, pt moaning with abdominal pain. On 11/9/00 at 01:00, pt moaning with increased temperature to 99 (ax), wheezing, restless and at 03:30 started coughing. SpO2 90%. Given Tylenol and Robitussin. At 21:40, pt moaning, wheezing in lower lobes. V/S 76/41, 114, 48, 97.4F (ax); SpO2 78%. Transferred by ambulance to hospital. Of the 21 individuals receiving immunizations 11/3/00, there were only 2 on prednisone that had sudden respiratory distress on the 6th day, post vax. Follow up received on 4/24/01 states the pt passed away on 2/7/01. Cause of Death - pneumonia.

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