National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 29960

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29960
VAERS Form:
Age:77.8
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-09
Submitted:1991-01-14
Entered:1991-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS PD02580P / 0 LA / -

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

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? No
Previous Vaccinations:
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


Changed on 12/8/2009

VAERS ID: 29960 Before After
VAERS Form:
Age:77.8
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-09
Submitted:1991-01-14
Entered:1991-04-23 1991-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS PD02580P / 0 LA / -

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

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? No
Previous Vaccinations:
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': (blank) MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


Changed on 8/31/2010

VAERS ID: 29960 Before After
VAERS Form:
Age:77.8
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-09
Submitted:1991-01-14
Entered:1991-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pneumonia

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? No
Previous Vaccinations:
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


Changed on 7/7/2013

VAERS ID: 29960 Before After
VAERS Form:
Age:77.8
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-09
Submitted:1991-01-14
Entered:1991-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 0 LA / -
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pneumonia

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? No
Previous Vaccinations:
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


Changed on 2/14/2017

VAERS ID: 29960 Before After
VAERS Form:
Age:77.8 77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-09
Submitted:1991-01-14
Entered:1991-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pneumonia

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? No
Previous Vaccinations:
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


Changed on 5/14/2017

VAERS ID: 29960 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-09
Submitted:1991-01-14
Entered:1991-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pneumonia

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


Changed on 9/14/2017

VAERS ID: 29960 Before After
VAERS Form:(blank) 1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-09
Submitted:1991-01-14
Entered:1991-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 0 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pneumonia

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


Changed on 2/14/2018

VAERS ID: 29960 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-09
Submitted:1991-01-14
Entered:1991-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pneumonia

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


Changed on 6/14/2018

VAERS ID: 29960 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-09
Submitted:1991-01-14
Entered:1991-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pneumonia

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


Changed on 8/14/2018

VAERS ID: 29960 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-09
Submitted:1991-01-14
Entered:1991-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pneumonia

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


Changed on 9/14/2018

VAERS ID: 29960 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-09
Submitted:1991-01-14
Entered:1991-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pneumonia

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM


Changed on 10/14/2018

VAERS ID: 29960 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-09
Submitted:1991-01-14
Entered:1991-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02580P / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Pneumonia

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pneumonia, chronic bronchitis
Preexisting Conditions: heart disease, chronic renal failure /w ADCVD, nephrosclerotic vasc disease,HTN,pulmonary emphysema, peripheral vasc disease
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': MD91019

Write-up: Acute myocardial infarction assoc /w ischemic heart disease. Cardiogenic shock&congestive heart failure due to acute MI.Viral pneumonia assoc /w recent Inflenza vax complicated by 2ndary bacterial pneumonia leading to resp failure..see WORM

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=29960&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166