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This is VAERS ID 313132

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 313132
VAERS Form:
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Blood culture negative, Cardiac arrest, Chest X-ray normal, Brain natriuretic peptide increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type':

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccinati"on, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shing


Changed on 12/8/2009

VAERS ID: 313132 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (NO BRAND NAME) INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Blood culture negative, Cardiac arrest, Chest X-ray normal, Death, Delirium, Dizziness, Echocardiogram normal, Herpes zoster, Listless, Myocardial infarction, Nausea, Pneumonia, Pulmonary oedema, Pyrexia, Rales, Vomiting, Brain natriuretic peptide increased, Troponin increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': (blank) 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccinati"on, vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shing shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 7/7/2013

VAERS ID: 313132 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Blood culture negative, Cardiac arrest, Chest X-ray normal, Death, Delirium, Dizziness, Echocardiogram normal, Herpes zoster, Listless, Myocardial infarction, Nausea, Pneumonia, Pulmonary oedema, Pyrexia, Rales, Vomiting, Brain natriuretic peptide increased, Troponin increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 12/14/2016

VAERS ID: 313132 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Blood culture negative, Cardiac arrest, Chest X-ray normal, Death, Delirium, Dizziness, Echocardiogram normal, Herpes zoster, Listless, Myocardial infarction, Nausea, Pneumonia, Pulmonary oedema, Pyrexia, Rales, Vomiting, Brain natriuretic peptide increased, Troponin increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 4/14/2017

VAERS ID: 313132 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Blood culture negative, Cardiac arrest, Chest X-ray normal, Death, Delirium, Dizziness, Echocardiogram normal, Herpes zoster, Listless, Myocardial infarction, Nausea, Pneumonia, Pulmonary oedema, Pyrexia, Rales, Vomiting, Brain natriuretic peptide increased, Troponin increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 9/14/2017

VAERS ID: 313132 Before After
VAERS Form:(blank) 1
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Dizziness, Herpes zoster, Myocardial infarction, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 2/14/2018

VAERS ID: 313132 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Dizziness, Herpes zoster, Myocardial infarction, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 6/14/2018

VAERS ID: 313132 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Dizziness, Herpes zoster, Myocardial infarction, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 8/14/2018

VAERS ID: 313132 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Dizziness, Herpes zoster, Myocardial infarction, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 9/14/2018

VAERS ID: 313132 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Dizziness, Herpes zoster, Myocardial infarction, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 10/14/2018

VAERS ID: 313132 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Dizziness, Herpes zoster, Myocardial infarction, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 12/24/2020

VAERS ID: 313132 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Dizziness, Herpes zoster, Myocardial infarction, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 12/30/2020

VAERS ID: 313132 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Dizziness, Herpes zoster, Myocardial infarction, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 5/7/2021

VAERS ID: 313132 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Dizziness, Herpes zoster, Myocardial infarction, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.


Changed on 5/21/2021

VAERS ID: 313132 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:New Mexico
Vaccinated:2007-11-29
Onset:2007-12-14
Submitted:2008-05-21
Entered:2008-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Dizziness, Herpes zoster, Myocardial infarction, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-01-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure. 6/18/08-records received-PMH: dementia, hypertension. osteoporosis, left hip fracture 11/05.
Allergies:
Diagnostic Lab Data: 6/18/08-records received-Sodium 130, BNP 2460. Troponin 0.04. CXR no acute finidng. Echocardiogram normal. blood culture negative.
CDC 'Split Type': 200801534

Write-up: This case was received from a consumer in the United Stated on 13 May 2008. A consumer reported that his 92-year-old mother received an injection of Influenza Vaccine (manufacturer and lot number not reported) on 29 November 2007. At the time of vaccination, the subject had high blood pressure. Two days after vaccination, on 01 December 2007, the patient began experiencing dizziness, nausea, and vomiting. She was diagnosed with pneumonia, and admitted to the hospital for 14 days. She later developed shingles on her forehead. She died on 12 January 2008; cause of death on the death certificate was "heart attack" according to the patient''s son. No autopsy was performed. 6/16/08-records received for 12/03/07-presented obtunded and unresponsive. Felt weak and limp, gurgling and wheezing, falling towards left side. Appeared to improved but had sudden listless and fever, delirious and gurgling. ED assessment:CHF exacerbation. Assessment viral versus bacterial community acquired pneumonia. 7/18/08-records received for DOS 12/4-12/7/07-DC DX: Community-acquired pneumonia. Pulmonary edema. Presented to ED less responsive than baseline. PE:rales. 9/24/08-records receivedOD-cardiac arrest. Probable myocardial infarction. Possible aspiration.

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