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This is VAERS ID 27141

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27141
VAERS Form:
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1990-10-22
Onset:1990-10-22
Submitted:0000-00-00
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1990-1991 LEDERLE / LEDERLE 287974 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: NAUSEA, PAIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-25
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:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died


Changed on 12/8/2009

VAERS ID: 27141 Before After
VAERS Form:
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1990-10-22
Onset:1990-10-22
Submitted:0000-00-00
Entered:1990-12-26 1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1990-1991 LEDERLE INFLUENZA (SEASONAL) (FLU-IMUNE 90-91) / LEDERLE LEDERLE LABORATORIES 287974 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nausea, Pain, NAUSEA, PAIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-25
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:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died


Changed on 8/31/2010

VAERS ID: 27141 Before After
VAERS Form:
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1990-10-22
Onset:1990-10-22
Submitted:0000-00-00
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE 90-91) INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287974 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nausea, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-25
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:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died


Changed on 7/7/2013

VAERS ID: 27141 Before After
VAERS Form:
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1990-10-22
Onset:1990-10-22
Submitted:0000-00-00
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287974 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287974 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nausea, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-25
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:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died


Changed on 5/14/2017

VAERS ID: 27141 Before After
VAERS Form:
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1990-10-22
Onset:1990-10-22
Submitted:0000-00-00
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287974 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nausea, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-25
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:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died


Changed on 9/14/2017

VAERS ID: 27141 Before After
VAERS Form:(blank) 1
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1990-10-22
Onset:1990-10-22
Submitted:0000-00-00
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287974 / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nausea, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-25
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:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died


Changed on 2/14/2018

VAERS ID: 27141 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1990-10-22
Onset:1990-10-22
Submitted:0000-00-00
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287974 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nausea, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-25
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:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died


Changed on 6/14/2018

VAERS ID: 27141 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1990-10-22
Onset:1990-10-22
Submitted:0000-00-00
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287974 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nausea, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-25
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:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died


Changed on 8/14/2018

VAERS ID: 27141 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1990-10-22
Onset:1990-10-22
Submitted:0000-00-00
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287974 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nausea, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-25
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:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died


Changed on 9/14/2018

VAERS ID: 27141 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1990-10-22
Onset:1990-10-22
Submitted:0000-00-00
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287974 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nausea, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-25
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:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died


Changed on 10/14/2018

VAERS ID: 27141 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1990-10-22
Onset:1990-10-22
Submitted:0000-00-00
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287974 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nausea, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-25
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:
Current Illness:
Preexisting Conditions: rash /w penicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax /w Flushot, B/P was 124/76, that evening @ 6:00 felt nauseated, @ 11:00 pm body ached all over, next day felt fine. Tues eve/Wed morn - he died

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