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This is VAERS ID 162101

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 162101
VAERS Form:
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:1999-10-14
Onset:1999-10-29
Submitted:2000-11-13
Entered:2000-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1999-2000 / WYETH 4998217 / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: COUGH INC, HEMOPTYSIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-12-23
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: 11     Extended hospital stay? No
Previous Vaccinations: Cough;UNK. INFLUENZA VACCINE;;82.00;In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC 'Split Type':

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.


Changed on 12/8/2009

VAERS ID: 162101 Before After
VAERS Form:
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:1999-10-14
Onset:1999-10-29
Submitted:2000-11-13
Entered:2000-11-20 2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1999-2000 INFLUENZA (SEASONAL) (FLUSHIELD 99-00) / WYETH WYETH PHARMACEUTICALS, INC 4998217 / 0 - / IM

Administered by: Other (blank)      Purchased by: Unknown (blank)
Symptoms: Cough, Haemoptysis, COUGH INC, HEMOPTYSIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-12-23
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: 11     Extended hospital stay? No
Previous Vaccinations: Cough;UNK. INFLUENZA VACCINE;;82.00;In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions: Hypertension, CHF, hypercholesterolemia,
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC 'Split Type':

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.


Changed on 8/31/2010

VAERS ID: 162101 Before After
VAERS Form:
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:1999-10-14
Onset:1999-10-29
Submitted:2000-11-13
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 99-00) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4998217 / 0 - / IM

Administered by: ??      Purchased by: ??
Symptoms: Cough, Haemoptysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-12-23
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: 11     Extended hospital stay? No
Previous Vaccinations: Cough;UNK. INFLUENZA VACCINE;;82.00;In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions: Hypertension, CHF, hypercholesterolemia,
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC 'Split Type':

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.


Changed on 7/7/2013

VAERS ID: 162101 Before After
VAERS Form:
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:1999-10-14
Onset:1999-10-29
Submitted:2000-11-13
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998217 / 0 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998217 / 0 - / IM

Administered by: ??      Purchased by: ??
Symptoms: Cough, Haemoptysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-12-23
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: 11     Extended hospital stay? No
Previous Vaccinations: Cough;UNK. INFLUENZA VACCINE;;82.00;In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions: Hypertension, CHF, hypercholesterolemia,
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC 'Split Type':

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.


Changed on 5/14/2017

VAERS ID: 162101 Before After
VAERS Form:
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:1999-10-14
Onset:1999-10-29
Submitted:2000-11-13
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998217 / 0 - / IM

Administered by: (blank) Unknown      Purchased by: (blank) Unknown
Symptoms: Cough, Haemoptysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-12-23
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: 11     Extended hospital stay? No
Previous Vaccinations: Cough;UNK. INFLUENZA VACCINE;;82.00;In Cough~Influenza (Seasonal) (no brand name)~~82.00~In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions: Hypertension, CHF, hypercholesterolemia,
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC 'Split Type':

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.


Changed on 9/14/2017

VAERS ID: 162101 Before After
VAERS Form:(blank) 1
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:1999-10-14
Onset:1999-10-29
Submitted:2000-11-13
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998217 / 0 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cough, Haemoptysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-12-23
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: 11     Extended hospital stay? No
Previous Vaccinations: Cough~Influenza (Seasonal) (no brand name)~~82.00~In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions: Hypertension, CHF, hypercholesterolemia,
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC 'Split Type':

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.


Changed on 2/14/2018

VAERS ID: 162101 Before After
VAERS Form:1
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:1999-10-14
Onset:1999-10-29
Submitted:2000-11-13
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998217 / 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cough, Haemoptysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-12-23
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: 11     Extended hospital stay? No
Previous Vaccinations: Cough~Influenza (Seasonal) (no brand name)~~82.00~In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions: Hypertension, CHF, hypercholesterolemia,
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC 'Split Type':

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.


Changed on 6/14/2018

VAERS ID: 162101 Before After
VAERS Form:1
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:1999-10-14
Onset:1999-10-29
Submitted:2000-11-13
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998217 / 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cough, Haemoptysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-12-23
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: 11     Extended hospital stay? No
Previous Vaccinations: Cough~Influenza (Seasonal) (no brand name)~~82.00~In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions: Hypertension, CHF, hypercholesterolemia,
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC 'Split Type':

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.


Changed on 8/14/2018

VAERS ID: 162101 Before After
VAERS Form:1
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:1999-10-14
Onset:1999-10-29
Submitted:2000-11-13
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998217 / 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cough, Haemoptysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-12-23
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: 11     Extended hospital stay? No
Previous Vaccinations: Cough~Influenza (Seasonal) (no brand name)~~82.00~In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions: Hypertension, CHF, hypercholesterolemia,
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC 'Split Type':

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.


Changed on 9/14/2018

VAERS ID: 162101 Before After
VAERS Form:1
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:1999-10-14
Onset:1999-10-29
Submitted:2000-11-13
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998217 / 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cough, Haemoptysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-12-23
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: 11     Extended hospital stay? No
Previous Vaccinations: Cough~Influenza (Seasonal) (no brand name)~~82.00~In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions: Hypertension, CHF, hypercholesterolemia,
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC 'Split Type':

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.


Changed on 10/14/2018

VAERS ID: 162101 Before After
VAERS Form:1
Age:83.0
Sex:Male
Location:Iowa
Vaccinated:1999-10-14
Onset:1999-10-29
Submitted:2000-11-13
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998217 / 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cough, Haemoptysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-12-23
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: 11     Extended hospital stay? No
Previous Vaccinations: Cough~Influenza (Seasonal) (no brand name)~~82.00~In Patient
Other Medications: Accupred, Lasix, K-Dur, Prilosec
Current Illness:
Preexisting Conditions: Hypertension, CHF, hypercholesterolemia,
Allergies:
Diagnostic Lab Data: X-rays, lung scrub, tests (nos).
CDC 'Split Type':

Write-up: Pt received flu shot on 10/14/1999, developed severe cough 10/29, was coughing up blood on 10/30. Was hospitalized 10/30 and received transfusion on 10/31. Tests were conducted and he was referred on 11/14. Pt died on 12/23/99.

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