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This is VAERS ID 27529

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27529
VAERS Form:
Age:78.2
Sex:Female
Location:New Hampshire
Vaccinated:1990-11-06
Onset:1990-11-07
Submitted:1991-01-18
Entered:1991-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11226 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: HEART FAIL RIGHT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-10
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


Changed on 12/8/2009

VAERS ID: 27529 Before After
VAERS Form:
Age:78.2
Sex:Female
Location:New Hampshire
Vaccinated:1990-11-06
Onset:1990-11-07
Submitted:1991-01-18
Entered:1991-01-25 1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11226 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Right ventricular failure, HEART FAIL RIGHT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-10
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


Changed on 8/31/2010

VAERS ID: 27529 Before After
VAERS Form:
Age:78.2
Sex:Female
Location:New Hampshire
Vaccinated:1990-11-06
Onset:1990-11-07
Submitted:1991-01-18
Entered:1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-10
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


Changed on 7/7/2013

VAERS ID: 27529 Before After
VAERS Form:
Age:78.2
Sex:Female
Location:New Hampshire
Vaccinated:1990-11-06
Onset:1990-11-07
Submitted:1991-01-18
Entered:1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-10
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


Changed on 2/14/2017

VAERS ID: 27529 Before After
VAERS Form:
Age:78.2 78.0
Sex:Female
Location:New Hampshire
Vaccinated:1990-11-06
Onset:1990-11-07
Submitted:1991-01-18
Entered:1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-10
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


Changed on 5/14/2017

VAERS ID: 27529 Before After
VAERS Form:
Age:78.0
Sex:Female
Location:New Hampshire
Vaccinated:1990-11-06
Onset:1990-11-07
Submitted:1991-01-18
Entered:1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-10
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


Changed on 9/14/2017

VAERS ID: 27529 Before After
VAERS Form:(blank) 1
Age:78.0
Sex:Female
Location:New Hampshire
Vaccinated:1990-11-06
Onset:1990-11-07
Submitted:1991-01-18
Entered:1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-10
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


Changed on 2/14/2018

VAERS ID: 27529 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:New Hampshire
Vaccinated:1990-11-06
Onset:1990-11-07
Submitted:1991-01-18
Entered:1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-10
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


Changed on 6/14/2018

VAERS ID: 27529 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:New Hampshire
Vaccinated:1990-11-06
Onset:1990-11-07
Submitted:1991-01-18
Entered:1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-10
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


Changed on 8/14/2018

VAERS ID: 27529 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:New Hampshire
Vaccinated:1990-11-06
Onset:1990-11-07
Submitted:1991-01-18
Entered:1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-10
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


Changed on 9/14/2018

VAERS ID: 27529 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:New Hampshire
Vaccinated:1990-11-06
Onset:1990-11-07
Submitted:1991-01-18
Entered:1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-10
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.


Changed on 10/14/2018

VAERS ID: 27529 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:New Hampshire
Vaccinated:1990-11-06
Onset:1990-11-07
Submitted:1991-01-18
Entered:1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Right ventricular failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-10
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3759

Write-up: Hospitalized 7NOV90 w/dx of CHF. In & out hosp over next few wks. Released again on 7DEC90 but readmitted 9DEC90 & died CHF. Not able to provide any other symptoms.

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