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This is VAERS ID 27275

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27275
VAERS Form:
Age:82.5
Sex:Male
Location:Minnesota
Vaccinated:1990-11-26
Onset:1990-11-26
Submitted:1990-12-26
Entered:1991-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 01870P / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-26
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: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


Changed on 12/8/2009

VAERS ID: 27275 Before After
VAERS Form:
Age:82.5
Sex:Male
Location:Minnesota
Vaccinated:1990-11-26
Onset:1990-11-26
Submitted:1990-12-26
Entered:1991-01-11 1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS 01870P / - LA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Apnoea, Cardiac arrest, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-26
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: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


Changed on 8/31/2010

VAERS ID: 27275 Before After
VAERS Form:
Age:82.5
Sex:Male
Location:Minnesota
Vaccinated:1990-11-26
Onset:1990-11-26
Submitted:1990-12-26
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-26
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: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


Changed on 7/7/2013

VAERS ID: 27275 Before After
VAERS Form:
Age:82.5
Sex:Male
Location:Minnesota
Vaccinated:1990-11-26
Onset:1990-11-26
Submitted:1990-12-26
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-26
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: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


Changed on 2/14/2017

VAERS ID: 27275 Before After
VAERS Form:
Age:82.5 82.0
Sex:Male
Location:Minnesota
Vaccinated:1990-11-26
Onset:1990-11-26
Submitted:1990-12-26
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-26
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: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


Changed on 5/14/2017

VAERS ID: 27275 Before After
VAERS Form:
Age:82.0
Sex:Male
Location:Minnesota
Vaccinated:1990-11-26
Onset:1990-11-26
Submitted:1990-12-26
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-26
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: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


Changed on 9/14/2017

VAERS ID: 27275 Before After
VAERS Form:(blank) 1
Age:82.0
Sex:Male
Location:Minnesota
Vaccinated:1990-11-26
Onset:1990-11-26
Submitted:1990-12-26
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / - UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-26
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: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


Changed on 2/14/2018

VAERS ID: 27275 Before After
VAERS Form:1
Age:82.0
Sex:Male
Location:Minnesota
Vaccinated:1990-11-26
Onset:1990-11-26
Submitted:1990-12-26
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-26
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: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


Changed on 6/14/2018

VAERS ID: 27275 Before After
VAERS Form:1
Age:82.0
Sex:Male
Location:Minnesota
Vaccinated:1990-11-26
Onset:1990-11-26
Submitted:1990-12-26
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-26
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: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


Changed on 8/14/2018

VAERS ID: 27275 Before After
VAERS Form:1
Age:82.0
Sex:Male
Location:Minnesota
Vaccinated:1990-11-26
Onset:1990-11-26
Submitted:1990-12-26
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-26
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: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


Changed on 9/14/2018

VAERS ID: 27275 Before After
VAERS Form:1
Age:82.0
Sex:Male
Location:Minnesota
Vaccinated:1990-11-26
Onset:1990-11-26
Submitted:1990-12-26
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-26
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: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.


Changed on 10/14/2018

VAERS ID: 27275 Before After
VAERS Form:1
Age:82.0
Sex:Male
Location:Minnesota
Vaccinated:1990-11-26
Onset:1990-11-26
Submitted:1990-12-26
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-26
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: Ascriptin, Metamucil
Current Illness:
Preexisting Conditions: No allergies, murmur, parkinson''s dsiease, arthritis, early cataracts, excision sebaceous cyst of back, benign keratosis of face.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLUOGEN apparent cardiac arrest - no breath/pulse 8PM - CPR initiated - transported to hosp where he expired.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=27275&WAYBACKHISTORY=ON


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