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This is VAERS ID 26655

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26655
VAERS Form:
Age:65.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-18
Onset:1990-10-25
Submitted:0000-00-00
Entered:1990-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F112117 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: PAIN BACK, ASTHENIA

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: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.


Changed on 12/8/2009

VAERS ID: 26655 Before After
VAERS Form:
Age:65.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-18
Onset:1990-10-25
Submitted:0000-00-00
Entered:1990-11-19 1990-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F112117 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Back pain, PAIN BACK, ASTHENIA

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: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.


Changed on 8/31/2010

VAERS ID: 26655 Before After
VAERS Form:
Age:65.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-18
Onset:1990-10-25
Submitted:0000-00-00
Entered:1990-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F112117 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Back pain

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: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.


Changed on 7/7/2013

VAERS ID: 26655 Before After
VAERS Form:
Age:65.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-18
Onset:1990-10-25
Submitted:0000-00-00
Entered:1990-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F112117 / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F112117 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Back pain

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: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.


Changed on 5/14/2017

VAERS ID: 26655 Before After
VAERS Form:
Age:65.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-18
Onset:1990-10-25
Submitted:0000-00-00
Entered:1990-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F112117 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Back pain

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: ~ ()~~~In patient
Other Medications: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.


Changed on 9/14/2017

VAERS ID: 26655 Before After
VAERS Form:(blank) 1
Age:65.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-18
Onset:1990-10-25
Submitted:0000-00-00
Entered:1990-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F112117 / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Back pain

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: ~ ()~~~In patient
Other Medications: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.


Changed on 2/14/2018

VAERS ID: 26655 Before After
VAERS Form:1
Age:65.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-18
Onset:1990-10-25
Submitted:0000-00-00
Entered:1990-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F112117 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Back pain

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: ~ ()~~~In patient
Other Medications: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.


Changed on 6/14/2018

VAERS ID: 26655 Before After
VAERS Form:1
Age:65.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-18
Onset:1990-10-25
Submitted:0000-00-00
Entered:1990-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F112117 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Back pain

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: ~ ()~~~In patient
Other Medications: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.


Changed on 8/14/2018

VAERS ID: 26655 Before After
VAERS Form:1
Age:65.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-18
Onset:1990-10-25
Submitted:0000-00-00
Entered:1990-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F112117 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Back pain

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: ~ ()~~~In patient
Other Medications: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.


Changed on 9/14/2018

VAERS ID: 26655 Before After
VAERS Form:1
Age:65.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-18
Onset:1990-10-25
Submitted:0000-00-00
Entered:1990-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F112117 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Back pain

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: ~ ()~~~In patient
Other Medications: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.


Changed on 10/14/2018

VAERS ID: 26655 Before After
VAERS Form:1
Age:65.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-18
Onset:1990-10-25
Submitted:0000-00-00
Entered:1990-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F112117 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Back pain

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: ~ ()~~~In patient
Other Medications: Calan SR 240MG 1/2 tab daily.
Current Illness:
Preexisting Conditions: Hx of hypertension, cigarette smoking.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluzone 1 wk after injection, had sudden death. 1 & 2 days before death c/o fatigue, low back pain and upper shoulder pain.

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