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This is VAERS ID 38733

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 38733
VAERS Form:
Age:79.2
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918138 / 0 RA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: VOMIT, SOMNOLENCE, MALAISE, HEART FAIL RIGHT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


Changed on 12/8/2009

VAERS ID: 38733 Before After
VAERS Form:
Age:79.2
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-15 1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918138 / 0 RA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting, VOMIT, SOMNOLENCE, MALAISE, HEART FAIL RIGHT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


Changed on 8/31/2010

VAERS ID: 38733 Before After
VAERS Form:
Age:79.2
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918138 / 0 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


Changed on 7/7/2013

VAERS ID: 38733 Before After
VAERS Form:
Age:79.2
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 0 RA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 0 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


Changed on 12/14/2016

VAERS ID: 38733 Before After
VAERS Form:
Age:79.2
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 0 RA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 0 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


Changed on 2/14/2017

VAERS ID: 38733 Before After
VAERS Form:
Age:79.2 79.0
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 0 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


Changed on 5/14/2017

VAERS ID: 38733 Before After
VAERS Form:
Age:79.0
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 0 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


Changed on 9/14/2017

VAERS ID: 38733 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 0 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


Changed on 2/14/2018

VAERS ID: 38733 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


Changed on 6/14/2018

VAERS ID: 38733 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


Changed on 8/14/2018

VAERS ID: 38733 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


Changed on 9/14/2018

VAERS ID: 38733 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;


Changed on 10/14/2018

VAERS ID: 38733 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Mississippi
Vaccinated:1991-10-13
Onset:1991-10-14
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Malaise, Right ventricular failure, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361004J

Write-up: 1 day p/receiving flu vax, pt exp sleepiness & c/o not feeling well; vomiting 2 days p/vax & the vomitus was noted to be brown; pt died on 17OCT91; COD congestive heart failure;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=38733&WAYBACKHISTORY=ON


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