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This is VAERS ID 36623

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36623
VAERS Form:
Age:70.4
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918129 / 3 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: HYPERGLYCEM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type':

Write-up: 20OCT91 pt expired;


Changed on 12/8/2009

VAERS ID: 36623 Before After
VAERS Form:
Age:70.4
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-12-02 1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918129 / 3 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Hyperglycaemia, HYPERGLYCEM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type': (blank) SD91025

Write-up: 20OCT91 pt expired;


Changed on 8/31/2010

VAERS ID: 36623 Before After
VAERS Form:
Age:70.4
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918129 / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hyperglycaemia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type': SD91025

Write-up: 20OCT91 pt expired;


Changed on 7/7/2013

VAERS ID: 36623 Before After
VAERS Form:
Age:70.4
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 3 LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hyperglycaemia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type': SD91025

Write-up: 20OCT91 pt expired;


Changed on 12/14/2016

VAERS ID: 36623 Before After
VAERS Form:
Age:70.4
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 3 LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hyperglycaemia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type': SD91025

Write-up: 20OCT91 pt expired;


Changed on 2/14/2017

VAERS ID: 36623 Before After
VAERS Form:
Age:70.4 70.0
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hyperglycaemia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type': SD91025

Write-up: 20OCT91 pt expired;


Changed on 5/14/2017

VAERS ID: 36623 Before After
VAERS Form:
Age:70.0
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hyperglycaemia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type': SD91025

Write-up: 20OCT91 pt expired;


Changed on 9/14/2017

VAERS ID: 36623 Before After
VAERS Form:(blank) 1
Age:70.0
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 3 4 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hyperglycaemia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type': SD91025

Write-up: 20OCT91 pt expired;


Changed on 2/14/2018

VAERS ID: 36623 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 4 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hyperglycaemia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type': SD91025

Write-up: 20OCT91 pt expired;


Changed on 6/14/2018

VAERS ID: 36623 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 4 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hyperglycaemia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type': SD91025

Write-up: 20OCT91 pt expired;


Changed on 8/14/2018

VAERS ID: 36623 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 4 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hyperglycaemia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type': SD91025

Write-up: 20OCT91 pt expired;


Changed on 9/14/2018

VAERS ID: 36623 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 4 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hyperglycaemia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type': SD91025

Write-up: 20OCT91 pt expired;


Changed on 10/14/2018

VAERS ID: 36623 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:South Dakota
Vaccinated:1991-10-07
Onset:1991-10-20
Submitted:1991-11-07
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 4 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hyperglycaemia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Capoten, Hunalin N 45U, Hunalin R 10U
Current Illness: Cardiopulmonary arrest
Preexisting Conditions: diabetes (insulin) hypertension alzheimers
Allergies:
Diagnostic Lab Data: fasting Blood sugar-133 (pt IDDM)
CDC 'Split Type': SD91025

Write-up: 20OCT91 pt expired;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=36623&WAYBACKHISTORY=ON


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