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This is VAERS ID 38735

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 38735
VAERS Form:
Age:78.0
Sex:Female
Location:Mississippi
Vaccinated:1991-10-08
Onset:1991-10-13
Submitted:1991-12-05
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918138 / 0 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: HYPOTENS, HEMATURIA, RHINITIS, PHARYNGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-26
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


Changed on 12/8/2009

VAERS ID: 38735 Before After
VAERS Form:
Age:78.0
Sex:Female
Location:Mississippi
Vaccinated:1991-10-08
Onset:1991-10-13
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 LA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis, HYPOTENS, HEMATURIA, RHINITIS, PHARYNGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-26
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


Changed on 8/31/2010

VAERS ID: 38735 Before After
VAERS Form:
Age:78.0
Sex:Female
Location:Mississippi
Vaccinated:1991-10-08
Onset:1991-10-13
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 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-26
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


Changed on 7/7/2013

VAERS ID: 38735 Before After
VAERS Form:
Age:78.0
Sex:Female
Location:Mississippi
Vaccinated:1991-10-08
Onset:1991-10-13
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-26
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


Changed on 12/14/2016

VAERS ID: 38735 Before After
VAERS Form:
Age:78.0
Sex:Female
Location:Mississippi
Vaccinated:1991-10-08
Onset:1991-10-13
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 0 LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-26
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


Changed on 5/14/2017

VAERS ID: 38735 Before After
VAERS Form:
Age:78.0
Sex:Female
Location:Mississippi
Vaccinated:1991-10-08
Onset:1991-10-13
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-26
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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


Changed on 9/14/2017

VAERS ID: 38735 Before After
VAERS Form:(blank) 1
Age:78.0
Sex:Female
Location:Mississippi
Vaccinated:1991-10-08
Onset:1991-10-13
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 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-26
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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


Changed on 2/14/2018

VAERS ID: 38735 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Mississippi
Vaccinated:1991-10-08
Onset:1991-10-13
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-26
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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


Changed on 6/14/2018

VAERS ID: 38735 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Mississippi
Vaccinated:1991-10-08
Onset:1991-10-13
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-26
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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


Changed on 8/14/2018

VAERS ID: 38735 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Mississippi
Vaccinated:1991-10-08
Onset:1991-10-13
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-26
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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


Changed on 9/14/2018

VAERS ID: 38735 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Mississippi
Vaccinated:1991-10-08
Onset:1991-10-13
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-26
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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;


Changed on 10/14/2018

VAERS ID: 38735 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Mississippi
Vaccinated:1991-10-08
Onset:1991-10-13
Submitted:1991-12-05
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918138 / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Haematuria, Hypotension, Pharyngitis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-26
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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891361002J

Write-up: Approx 5 days p/flu vax pt devel cold sx from which pt never recovered; On 25OCT91 pt exp hematuria & hypotension & died following day; COD was not felt to be secondary to the flu vax;

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