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This is VAERS ID 37817

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 37817
VAERS Form:
Age:46.6
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918169 / 0 A / IM

Administered by: Public      Purchased by: Unknown
Symptoms: APNEA, ASTHMA, ANAPHYL, HEART ARREST, BRONCHITIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt ""arrested"" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


Changed on 12/8/2009

VAERS ID: 37817 Before After
VAERS Form:
Age:46.6
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-12 1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918169 / 0 A / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated, APNEA, ASTHMA, ANAPHYL, HEART ARREST, BRONCHITIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt ""arrested"" "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


Changed on 8/31/2010

VAERS ID: 37817 Before After
VAERS Form:
Age:46.6
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918169 / 0 A / IM

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


Changed on 7/7/2013

VAERS ID: 37817 Before After
VAERS Form:
Age:46.6
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 0 A / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 0 A / IM

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


Changed on 12/14/2016

VAERS ID: 37817 Before After
VAERS Form:
Age:46.6
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 0 A / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 0 A / IM

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


Changed on 2/14/2017

VAERS ID: 37817 Before After
VAERS Form:
Age:46.6 46.0
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 0 A / IM

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


Changed on 5/14/2017

VAERS ID: 37817 Before After
VAERS Form:
Age:46.0
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 0 A - / IM IM A

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: UNK
Preexisting Conditions: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


Changed on 9/14/2017

VAERS ID: 37817 Before After
VAERS Form:(blank) 1
Age:46.0
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 0 1 - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: UNK
Preexisting Conditions: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


Changed on 2/14/2018

VAERS ID: 37817 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: UNK
Preexisting Conditions: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


Changed on 6/14/2018

VAERS ID: 37817 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: UNK
Preexisting Conditions: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


Changed on 8/14/2018

VAERS ID: 37817 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: UNK
Preexisting Conditions: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


Changed on 9/14/2018

VAERS ID: 37817 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: UNK
Preexisting Conditions: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;


Changed on 10/14/2018

VAERS ID: 37817 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Connecticut
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-19
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Apnoea, Asthma, Bronchitis, Cardiac arrest, Condition aggravated

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-11-18
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: UNK
Preexisting Conditions: pt had a hx of chronic, controlled asthma, & was possibly taking meds for this; allergies;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891325001J

Write-up: Pt recvd flu vax on 18NOV91 between 11AM & 2PM; that night pt "arrested" @ home; EMS were summoned, but pt died; pt suffered an asthma attack; no autopsy was performed; Prior to vax survey form pt didn''t indicate allergy to eggs;

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