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This is VAERS ID 376990

History of Changes from the VAERS Wayback Machine

First Appeared on 2/5/2010

VAERS ID: 376990
VAERS Form:
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (INFLUENZA A (H1N1) 2009 MONOVALENT) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 6/2/2010

VAERS ID: 376990 Before After
VAERS Form:
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
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) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 4/13/2011

VAERS ID: 376990 Before After
VAERS Form:
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death, Obesity, Pulmonary embolism, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 5/13/2011

VAERS ID: 376990 Before After
VAERS Form:
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death, Obesity, Pulmonary embolism, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 6/11/2011

VAERS ID: 376990 Before After
VAERS Form:
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death, Obesity, Pulmonary embolism, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 7/12/2011

VAERS ID: 376990 Before After
VAERS Form:
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death, Obesity, Pulmonary embolism, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 3/14/2015

VAERS ID: 376990 Before After
VAERS Form:
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death, Obesity, Pulmonary embolism, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 2/14/2017

VAERS ID: 376990 Before After
VAERS Form:
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS) INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 9/14/2017

VAERS ID: 376990 Before After
VAERS Form:(blank) 1
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 0 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 2/14/2018

VAERS ID: 376990 Before After
VAERS Form:1
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 6/14/2018

VAERS ID: 376990 Before After
VAERS Form:1
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 8/14/2018

VAERS ID: 376990 Before After
VAERS Form:1
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 9/14/2018

VAERS ID: 376990 Before After
VAERS Form:1
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 10/14/2018

VAERS ID: 376990 Before After
VAERS Form:1
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 12/24/2020

VAERS ID: 376990 Before After
VAERS Form:1
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 12/30/2020

VAERS ID: 376990 Before After
VAERS Form:1
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 5/7/2021

VAERS ID: 376990 Before After
VAERS Form:1
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown


Changed on 5/14/2021

VAERS ID: 376990 Before After
VAERS Form:1
Age:38.0
Sex:Female
Location:Minnesota
Vaccinated:2010-01-08
Onset:2010-01-10
Submitted:2010-01-14
Entered:2010-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)) / NOVARTIS VACCINES AND DIAGNOSTICS 500805P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-10
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:
Current Illness: no
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: unknown

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=376990&WAYBACKHISTORY=ON


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