National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 26713

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26713
VAERS Form:
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 02580P / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: APNEA, PNEUMONIA, HEART ARREST, SHOCK

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-09
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:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & ""a lump in his chest"" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


Changed on 12/30/2006

VAERS ID: 26713 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-02
Submitted:0000-00-00
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 02580P / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: APNEA, PNEUMONIA, HEART ARREST, SHOCK

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-09
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:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & ""a /"a lump in his chest"" chest/" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


Changed on 12/8/2009

VAERS ID: 26713 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-02
Submitted:0000-00-00
Entered:1990-11-27 1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS 02580P / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock, APNEA, PNEUMONIA, HEART ARREST, SHOCK

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-09
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:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 904090003

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & /"a "a lump in his chest/" chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


Changed on 8/31/2010

VAERS ID: 26713 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-02
Submitted:0000-00-00
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-09
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:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090003

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


Changed on 7/7/2013

VAERS ID: 26713 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-02
Submitted:0000-00-00
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-09
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:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090003

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


Changed on 5/14/2017

VAERS ID: 26713 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-02
Submitted:0000-00-00
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-09
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090003

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


Changed on 9/14/2017

VAERS ID: 26713 Before After
VAERS Form:(blank) 1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-02
Submitted:0000-00-00
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-09
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090003

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


Changed on 2/14/2018

VAERS ID: 26713 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-02
Submitted:0000-00-00
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-09
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090003

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


Changed on 6/14/2018

VAERS ID: 26713 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-02
Submitted:0000-00-00
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-09
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090003

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


Changed on 8/14/2018

VAERS ID: 26713 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-02
Submitted:0000-00-00
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-09
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090003

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


Changed on 9/14/2018

VAERS ID: 26713 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-02
Submitted:0000-00-00
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-09
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090003

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.


Changed on 10/14/2018

VAERS ID: 26713 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-02
Submitted:0000-00-00
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Pneumonia, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-09
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Pt hx of COPD, CABG, Chronic renal fialure, had flu shots in the past without problems.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090003

Write-up: Pt vaccinated with Fluogen 10-2-90 & on 10-7-90 had nausea. On 10-8-90, had dyspnea & "a lump in his chest" seen in ER; Dx as having RLL infiltrate & R/O AMI. Had respiratory failure & cardiac arrest & died on 10-9-90.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=26713&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166