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This is VAERS ID 31684

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 31684
VAERS Form:
Age:34.7
Sex:Male
Location:Iowa
Vaccinated:1990-11-01
Onset:1990-11-18
Submitted:1991-06-03
Entered:1991-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11211 / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: OCCLUS

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: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC 'Split Type':

Write-up: Cervical spine cord infarction & subsequent death;


Changed on 12/8/2009

VAERS ID: 31684 Before After
VAERS Form:
Age:34.7
Sex:Male
Location:Iowa
Vaccinated:1990-11-01
Onset:1990-11-18
Submitted:1991-06-03
Entered:1991-06-27 1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11211 / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Vascular occlusion, OCCLUS

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: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC 'Split Type': (blank) IA910018

Write-up: Cervical spine cord infarction & subsequent death;


Changed on 8/31/2010

VAERS ID: 31684 Before After
VAERS Form:
Age:34.7
Sex:Male
Location:Iowa
Vaccinated:1990-11-01
Onset:1990-11-18
Submitted:1991-06-03
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11211 / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Vascular occlusion

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: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC 'Split Type': IA910018

Write-up: Cervical spine cord infarction & subsequent death;


Changed on 7/7/2013

VAERS ID: 31684 Before After
VAERS Form:
Age:34.7
Sex:Male
Location:Iowa
Vaccinated:1990-11-01
Onset:1990-11-18
Submitted:1991-06-03
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11211 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11211 / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Vascular occlusion

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: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC 'Split Type': IA910018

Write-up: Cervical spine cord infarction & subsequent death;


Changed on 2/14/2017

VAERS ID: 31684 Before After
VAERS Form:
Age:34.7 34.0
Sex:Male
Location:Iowa
Vaccinated:1990-11-01
Onset:1990-11-18
Submitted:1991-06-03
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11211 / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Vascular occlusion

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: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC 'Split Type': IA910018

Write-up: Cervical spine cord infarction & subsequent death;


Changed on 5/14/2017

VAERS ID: 31684 Before After
VAERS Form:
Age:34.0
Sex:Male
Location:Iowa
Vaccinated:1990-11-01
Onset:1990-11-18
Submitted:1991-06-03
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11211 / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Vascular occlusion

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: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC 'Split Type': IA910018

Write-up: Cervical spine cord infarction & subsequent death;


Changed on 9/14/2017

VAERS ID: 31684 Before After
VAERS Form:(blank) 1
Age:34.0
Sex:Male
Location:Iowa
Vaccinated:1990-11-01
Onset:1990-11-18
Submitted:1991-06-03
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11211 / - UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Vascular occlusion

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: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC 'Split Type': IA910018

Write-up: Cervical spine cord infarction & subsequent death;


Changed on 2/14/2018

VAERS ID: 31684 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:Iowa
Vaccinated:1990-11-01
Onset:1990-11-18
Submitted:1991-06-03
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11211 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Vascular occlusion

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: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC 'Split Type': IA910018

Write-up: Cervical spine cord infarction & subsequent death;


Changed on 6/14/2018

VAERS ID: 31684 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:Iowa
Vaccinated:1990-11-01
Onset:1990-11-18
Submitted:1991-06-03
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11211 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Vascular occlusion

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: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC 'Split Type': IA910018

Write-up: Cervical spine cord infarction & subsequent death;


Changed on 8/14/2018

VAERS ID: 31684 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:Iowa
Vaccinated:1990-11-01
Onset:1990-11-18
Submitted:1991-06-03
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11211 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Vascular occlusion

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: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC 'Split Type': IA910018

Write-up: Cervical spine cord infarction & subsequent death;


Changed on 9/14/2018

VAERS ID: 31684 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:Iowa
Vaccinated:1990-11-01
Onset:1990-11-18
Submitted:1991-06-03
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11211 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Vascular occlusion

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: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC 'Split Type': IA910018

Write-up: Cervical spine cord infarction & subsequent death;


Changed on 10/14/2018

VAERS ID: 31684 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:Iowa
Vaccinated:1990-11-01
Onset:1990-11-18
Submitted:1991-06-03
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11211 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Vascular occlusion

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: No medications
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report
CDC 'Split Type': IA910018

Write-up: Cervical spine cord infarction & subsequent death;

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