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This is VAERS ID 37800

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 37800
VAERS Form:
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-26
Entered:1991-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918122 / 0 A / -

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, HYPOTENS, HEADACHE, CONFUS, EDEMA BRAIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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: UNK
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 4SEP91 WBC-13,600
CDC 'Split Type':

Write-up: Pt recvd flu vax 27AUG91; 03SEP91 pt noted to have h/a, acting strangely & was taken to ER, where sz ensued; also lethargic, unrespoonsive, color became poor; BP dropped; bright red blood was noted from rectum; encephalitis;


Changed on 12/8/2009

VAERS ID: 37800 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-26 1991-11-15
Entered:1991-12-10 1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918122 / 0 A / -

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Cardiac arrest, Encephalitis, Gastritis haemorrhagic, Grand mal convulsion, Infection, CONVULS, HYPOTENS, HEADACHE, CONFUS, EDEMA BRAIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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 Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 4SEP91 WBC-13,600
CDC 'Split Type': (blank) 891326001J

Write-up: Pt recvd flu vax 27AUG91; 03SEP91 pt noted to have h/a, acting strangely & was taken to ER, where sz ensued; also lethargic, unrespoonsive, color became poor; BP dropped; bright red blood was noted from rectum; encephalitis;


Changed on 8/31/2010

VAERS ID: 37800 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-15
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918122 / 0 A / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Cardiac arrest, Encephalitis, Gastritis haemorrhagic, Grand mal convulsion, Infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 4SEP91 WBC-13,600
CDC 'Split Type': 891326001J

Write-up: Pt recvd flu vax 27AUG91; 03SEP91 pt noted to have h/a, acting strangely & was taken to ER, where sz ensued; also lethargic, unrespoonsive, color became poor; BP dropped; bright red blood was noted from rectum; encephalitis;


Changed on 4/13/2011

VAERS ID: 37800 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-15
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 0 A / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Cardiac arrest, Encephalitis, Gastritis haemorrhagic, Grand mal convulsion, Infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 4SEP91 WBC-13,600
CDC 'Split Type': 891326001J

Write-up: Pt recvd flu vax 27AUG91; 03SEP91 pt noted to have h/a, acting strangely & was taken to ER, where sz ensued; also lethargic, unrespoonsive, color became poor; BP dropped; bright red blood was noted from rectum; encephalitis;


Changed on 5/13/2011

VAERS ID: 37800 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-15
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 0 A / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Cardiac arrest, Encephalitis, Gastritis haemorrhagic, Grand mal convulsion, Infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 4SEP91 WBC-13,600
CDC 'Split Type': 891326001J

Write-up: Pt recvd flu vax 27AUG91; 03SEP91 pt noted to have h/a, acting strangely & was taken to ER, where sz ensued; also lethargic, unrespoonsive, color became poor; BP dropped; bright red blood was noted from rectum; encephalitis;


Changed on 6/11/2011

VAERS ID: 37800 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-15
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 0 A / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Cardiac arrest, Encephalitis, Gastritis haemorrhagic, Grand mal convulsion, Infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 4SEP91 WBC-13,600
CDC 'Split Type': 891326001J

Write-up: Pt recvd flu vax 27AUG91; 03SEP91 pt noted to have h/a, acting strangely & was taken to ER, where sz ensued; also lethargic, unrespoonsive, color became poor; BP dropped; bright red blood was noted from rectum; encephalitis;


Changed on 7/7/2013

VAERS ID: 37800 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-15
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 0 A / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 0 A / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Cardiac arrest, Encephalitis, Gastritis haemorrhagic, Grand mal convulsion, Infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 4SEP91 WBC-13,600
CDC 'Split Type': 891326001J

Write-up: Pt recvd flu vax 27AUG91; 03SEP91 pt noted to have h/a, acting strangely & was taken to ER, where sz ensued; also lethargic, unrespoonsive, color became poor; BP dropped; bright red blood was noted from rectum; encephalitis;


Changed on 12/14/2016

VAERS ID: 37800 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-15
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 0 A / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 0 A / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Cardiac arrest, Encephalitis, Gastritis haemorrhagic, Grand mal convulsion, Infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 4SEP91 WBC-13,600
CDC 'Split Type': 891326001J

Write-up: Pt recvd flu vax 27AUG91; 03SEP91 pt noted to have h/a, acting strangely & was taken to ER, where sz ensued; also lethargic, unrespoonsive, color became poor; BP dropped; bright red blood was noted from rectum; encephalitis;


Changed on 5/14/2017

VAERS ID: 37800 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-15 1991-11-26
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 0 A - / - A

Administered by: Unknown Private      Purchased by: Unknown Private
Symptoms: Acidosis, Apnoea, Cardiac arrest, Confusional state, Convulsion, Encephalitis, Gastritis haemorrhagic, Grand mal convulsion, Headache, Hypotension, Infection, Vomiting, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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 No, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: 4SEP91 WBC-13,600 Autopsy-culture neg; massive cerebral swelling, perivascular lymphocyte cuffing;
CDC 'Split Type': 891326001J IA910040

Write-up: Pt recvd flu vax 27AUG91; 03SEP91 pt noted to have h/a, acting strangely & was taken to ER, where 3SEP91 onset of severe rt sided h/a; emesis x 1; 4SEP91 awoke confused, devel generalized sz ensued; also lethargic, unrespoonsive, color became poor; BP dropped; bright red blood was noted from rectum; encephalitis; hypotensive;


Changed on 9/14/2017

VAERS ID: 37800 Before After
VAERS Form:(blank) 1
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-26
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 0 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: Confusional state, Convulsion, Headache, Hypotension, Vomiting, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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: UNK
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: Autopsy-culture neg; massive cerebral swelling, perivascular lymphocyte cuffing;
CDC 'Split Type': IA910040

Write-up: 3SEP91 onset of severe rt sided h/a; emesis x 1; 4SEP91 awoke confused, devel generalized sz became hypotensive;


Changed on 2/14/2018

VAERS ID: 37800 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-26
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: Confusional state, Convulsion, Headache, Hypotension, Vomiting, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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: UNK
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: Autopsy-culture neg; massive cerebral swelling, perivascular lymphocyte cuffing;
CDC 'Split Type': IA910040

Write-up: 3SEP91 onset of severe rt sided h/a; emesis x 1; 4SEP91 awoke confused, devel generalized sz became hypotensive;


Changed on 6/14/2018

VAERS ID: 37800 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-26
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: Confusional state, Convulsion, Headache, Hypotension, Vomiting, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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: UNK
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: Autopsy-culture neg; massive cerebral swelling, perivascular lymphocyte cuffing;
CDC 'Split Type': IA910040

Write-up: 3SEP91 onset of severe rt sided h/a; emesis x 1; 4SEP91 awoke confused, devel generalized sz became hypotensive;


Changed on 8/14/2018

VAERS ID: 37800 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-26
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: Confusional state, Convulsion, Headache, Hypotension, Vomiting, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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: UNK
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: Autopsy-culture neg; massive cerebral swelling, perivascular lymphocyte cuffing;
CDC 'Split Type': IA910040

Write-up: 3SEP91 onset of severe rt sided h/a; emesis x 1; 4SEP91 awoke confused, devel generalized sz became hypotensive;


Changed on 9/14/2018

VAERS ID: 37800 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-26
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: Confusional state, Convulsion, Headache, Hypotension, Vomiting, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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: UNK
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: Autopsy-culture neg; massive cerebral swelling, perivascular lymphocyte cuffing;
CDC 'Split Type': IA910040

Write-up: 3SEP91 onset of severe rt sided h/a; emesis x 1; 4SEP91 awoke confused, devel generalized sz became hypotensive;


Changed on 10/14/2018

VAERS ID: 37800 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-08-27
Onset:1991-09-03
Submitted:1991-11-26
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918122 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: Confusional state, Convulsion, Headache, Hypotension, Vomiting, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-04
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: UNK
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: Autopsy-culture neg; massive cerebral swelling, perivascular lymphocyte cuffing;
CDC 'Split Type': IA910040

Write-up: 3SEP91 onset of severe rt sided h/a; emesis x 1; 4SEP91 awoke confused, devel generalized sz became hypotensive;

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