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This is VAERS ID 38163

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 38163
VAERS Form:
Age:59.7
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1992-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918136 / 5 - / -

Administered by: Public      Purchased by: Unknown
Symptoms: APNEA, HEART ARREST, HEM CEREBR, CEREBROVASC ACCID, ANOMALY VASCUL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


Changed on 12/8/2009

VAERS ID: 38163 Before After
VAERS Form:
Age:59.7
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1992-01-02 1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918136 / 5 - / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly, APNEA, HEART ARREST, HEM CEREBR, CEREBROVASC ACCID, ANOMALY VASCUL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


Changed on 8/31/2010

VAERS ID: 38163 Before After
VAERS Form:
Age:59.7
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918136 / 5 - / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


Changed on 7/7/2013

VAERS ID: 38163 Before After
VAERS Form:
Age:59.7
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 5 - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 5 - / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


Changed on 12/14/2016

VAERS ID: 38163 Before After
VAERS Form:
Age:59.7
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 5 - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 5 - / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


Changed on 2/14/2017

VAERS ID: 38163 Before After
VAERS Form:
Age:59.7 59.0
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 5 - / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


Changed on 5/14/2017

VAERS ID: 38163 Before After
VAERS Form:
Age:59.0
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 5 - / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


Changed on 9/14/2017

VAERS ID: 38163 Before After
VAERS Form:(blank) 1
Age:59.0
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 5 6 - / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


Changed on 2/14/2018

VAERS ID: 38163 Before After
VAERS Form:1
Age:59.0
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 6 - / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


Changed on 6/14/2018

VAERS ID: 38163 Before After
VAERS Form:1
Age:59.0
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 6 - / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


Changed on 8/14/2018

VAERS ID: 38163 Before After
VAERS Form:1
Age:59.0
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 6 - / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


Changed on 9/14/2018

VAERS ID: 38163 Before After
VAERS Form:1
Age:59.0
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 6 - / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;


Changed on 10/14/2018

VAERS ID: 38163 Before After
VAERS Form:1
Age:59.0
Sex:Female
Location:Georgia
Vaccinated:1991-11-06
Onset:1991-11-08
Submitted:1991-11-15
Entered:1991-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918136 / 6 - / -

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Cerebral haemorrhage, Cerebrovascular accident, Hypertension, Vascular anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: Trilafor
Current Illness: NONE
Preexisting Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91323

Write-up: Pt''s husband reported pt was well until apparent stroke 8NOV91 @ 12noon; pt then died 9NOV91 @ 235AM; no autopsy was done; Cause of death listed as possible aneurysm;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=38163&WAYBACKHISTORY=ON


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