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This is VAERS ID 38150

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 38150
VAERS Form:
Age:84.9
Sex:Male
Location:Oklahoma
Vaccinated:1991-12-04
Onset:1991-12-04
Submitted:1991-12-20
Entered:1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 1F21214 / - LA / -

Administered by: Public      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-04
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: No
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': Unknown;

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


Changed on 12/8/2009

VAERS ID: 38150 Before After
VAERS Form:
Age:84.9
Sex:Male
Location:Oklahoma
Vaccinated:1991-12-04
Onset:1991-12-04
Submitted:1991-12-20
Entered:1991-12-30 1991-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1F21214 / - LA / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-04
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: No
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': Unknown; OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


Changed on 8/31/2010

VAERS ID: 38150 Before After
VAERS Form:
Age:84.9
Sex:Male
Location:Oklahoma
Vaccinated:1991-12-04
Onset:1991-12-04
Submitted:1991-12-20
Entered:1991-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / - LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-04
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: No
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


Changed on 7/7/2013

VAERS ID: 38150 Before After
VAERS Form:
Age:84.9
Sex:Male
Location:Oklahoma
Vaccinated:1991-12-04
Onset:1991-12-04
Submitted:1991-12-20
Entered:1991-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / - LA / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / - LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-04
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: No
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


Changed on 2/14/2017

VAERS ID: 38150 Before After
VAERS Form:
Age:84.9 84.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-12-04
Onset:1991-12-04
Submitted:1991-12-20
Entered:1991-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / - LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-04
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: No
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


Changed on 5/14/2017

VAERS ID: 38150 Before After
VAERS Form:
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-12-04
Onset:1991-12-04
Submitted:1991-12-20
Entered:1991-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / - LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-04
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: No No~ ()~~~In patient
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


Changed on 9/14/2017

VAERS ID: 38150 Before After
VAERS Form:(blank) 1
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-12-04
Onset:1991-12-04
Submitted:1991-12-20
Entered:1991-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / - UNK LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-04
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: No~ ()~~~In patient
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


Changed on 2/14/2018

VAERS ID: 38150 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-12-04
Onset:1991-12-04
Submitted:1991-12-20
Entered:1991-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / UNK LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-04
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: No~ ()~~~In patient
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


Changed on 6/14/2018

VAERS ID: 38150 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-12-04
Onset:1991-12-04
Submitted:1991-12-20
Entered:1991-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / UNK LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-04
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: No~ ()~~~In patient
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


Changed on 8/14/2018

VAERS ID: 38150 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-12-04
Onset:1991-12-04
Submitted:1991-12-20
Entered:1991-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / UNK LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-04
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: No~ ()~~~In patient
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


Changed on 9/14/2018

VAERS ID: 38150 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-12-04
Onset:1991-12-04
Submitted:1991-12-20
Entered:1991-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / UNK LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-04
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: No~ ()~~~In patient
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;


Changed on 10/14/2018

VAERS ID: 38150 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-12-04
Onset:1991-12-04
Submitted:1991-12-20
Entered:1991-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / UNK LA / -

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-04
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: No~ ()~~~In patient
Other Medications: Unknown;
Current Illness: Chronic heart disease;
Preexisting Conditions: Unknown;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9182

Write-up: Expired 04DEC91; medical examiner called Health Dept - death not due to vax;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=38150&WAYBACKHISTORY=ON


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