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This is VAERS ID 376969

History of Changes from the VAERS Wayback Machine

First Appeared on 2/5/2010

VAERS ID: 376969
VAERS Form:
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (INFLUENZA A (H1N1) 2009 MONOVALENT) / SANOFI PASTEUR UP035BA / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 6/2/2010

VAERS ID: 376969 Before After
VAERS Form:
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (INFLUENZA A (H1N1) 2009 MONOVALENT) INFLUENZA (H1N1) (H1N1 (MONOVALENT) SANOFI) / SANOFI PASTEUR UP035BA / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 7/31/2010

VAERS ID: 376969 Before After
VAERS Form:
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) SANOFI) / SANOFI PASTEUR UP035BA / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased, Lymphoplasmacytoid lymphoma/immunocytoma, Packed red blood cell transfusion, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 4/13/2011

VAERS ID: 376969 Before After
VAERS Form:
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) SANOFI) / SANOFI PASTEUR UP035BA / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Anaemia, Cardiomyopathy, Coagulopathy, Condition aggravated, Death, Drug interaction, Injection site haematoma, International normalised ratio increased, Lymphoplasmacytoid lymphoma/immunocytoma, Muscle spasms, Myelodysplastic syndrome, Non-Hodgkin's lymphoma, Packed red blood cell transfusion, Pain in extremity, Vaccination complication, General physical health deterioration, Transfusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 5/13/2011

VAERS ID: 376969 Before After
VAERS Form:
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) SANOFI) / SANOFI PASTEUR UP035BA / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Anaemia, Cardiomyopathy, Coagulopathy, Condition aggravated, Death, Drug interaction, Injection site haematoma, International normalised ratio increased, Lymphoplasmacytoid lymphoma/immunocytoma, Muscle spasms, Myelodysplastic syndrome, Non-Hodgkin's lymphoma, Packed red blood cell transfusion, Pain in extremity, Vaccination complication, General physical health deterioration, Transfusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 6/11/2011

VAERS ID: 376969 Before After
VAERS Form:
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) SANOFI) / SANOFI PASTEUR UP035BA / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Anaemia, Cardiomyopathy, Coagulopathy, Condition aggravated, Death, Drug interaction, Injection site haematoma, International normalised ratio increased, Lymphoplasmacytoid lymphoma/immunocytoma, Muscle spasms, Myelodysplastic syndrome, Non-Hodgkin's lymphoma, Packed red blood cell transfusion, Pain in extremity, Vaccination complication, General physical health deterioration, Transfusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 11/13/2012

VAERS ID: 376969 Before After
VAERS Form:
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) SANOFI) INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI) / SANOFI PASTEUR UP035BA / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Anaemia, Cardiomyopathy, Coagulopathy, Condition aggravated, Death, Drug interaction, Injection site haematoma, International normalised ratio increased, Lymphoplasmacytoid lymphoma/immunocytoma, Muscle spasms, Myelodysplastic syndrome, Non-Hodgkin's lymphoma, Packed red blood cell transfusion, Pain in extremity, Vaccination complication, General physical health deterioration, Transfusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 6/14/2014

VAERS ID: 376969 Before After
VAERS Form:
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI) / SANOFI PASTEUR UP035BA / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Anaemia, Cardiomyopathy, Coagulopathy, Condition aggravated, Death, Drug interaction, Injection site haematoma, International normalised ratio increased, Lymphoplasmacytoid lymphoma/immunocytoma, Muscle spasms, Myelodysplastic syndrome, Non-Hodgkin's lymphoma, Packed red blood cell transfusion, Pain in extremity, Vaccination complication, General physical health deterioration, Transfusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 3/14/2015

VAERS ID: 376969 Before After
VAERS Form:
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI) / SANOFI PASTEUR UP035BA / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Anaemia, Cardiomyopathy, Coagulopathy, Condition aggravated, Death, Drug interaction, Injection site haematoma, International normalised ratio increased, Lymphoplasmacytoid lymphoma/immunocytoma, Muscle spasms, Myelodysplastic syndrome, Non-Hodgkin's lymphoma, Packed red blood cell transfusion, Pain in extremity, Vaccination complication, General physical health deterioration, Transfusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 2/14/2017

VAERS ID: 376969 Before After
VAERS Form:
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI) INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 9/14/2017

VAERS ID: 376969 Before After
VAERS Form:(blank) 1
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 0 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 2/14/2018

VAERS ID: 376969 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 6/14/2018

VAERS ID: 376969 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 8/14/2018

VAERS ID: 376969 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 9/14/2018

VAERS ID: 376969 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 10/14/2018

VAERS ID: 376969 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Unknown
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 12/10/2020

VAERS ID: 376969 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Unknown Virginia
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 12/24/2020

VAERS ID: 376969 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Virginia
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 12/30/2020

VAERS ID: 376969 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Virginia
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 5/7/2021

VAERS ID: 376969 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Virginia
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.


Changed on 5/14/2021

VAERS ID: 376969 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Virginia
Vaccinated:2010-01-06
Onset:2010-01-09
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP035BA / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Coagulopathy, Death, Drug interaction, International normalised ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: COUMADIN
Current Illness: NonHodgkins Lymphoma
Preexisting Conditions: lymphoma; chronic DVT
Allergies:
Diagnostic Lab Data: Increased INR
CDC 'Split Type':

Write-up: Suspect H1N1 caused interaction with COUMADIN/coagulation.

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