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This is VAERS ID 38816

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 38816
VAERS Form:
Age:81.3
Sex:Male
Location:Nevada
Vaccinated:1991-11-26
Onset:1991-12-18
Submitted:1992-01-07
Entered:1992-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 / PARKE-DAVIS 01481P / 0 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: APNEA, MYALGIA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-18
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: UNK
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CHF, COPD

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


Changed on 12/8/2009

VAERS ID: 38816 Before After
VAERS Form:
Age:81.3
Sex:Male
Location:Nevada
Vaccinated:1991-11-26
Onset:1991-12-18
Submitted:1992-01-07
Entered:1992-01-17 1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 INFLUENZA (SEASONAL) (FLUOGEN 91-92) / PARKE-DAVIS 01481P / 0 LA / IM

Administered by: Other      Purchased by: Unknown Public
Symptoms: Apnoea, Cardiac arrest, Myalgia, APNEA, MYALGIA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-18
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: UNK
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CHF, COPD NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


Changed on 8/31/2010

VAERS ID: 38816 Before After
VAERS Form:
Age:81.3
Sex:Male
Location:Nevada
Vaccinated:1991-11-26
Onset:1991-12-18
Submitted:1992-01-07
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 91-92) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 0 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myalgia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-18
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: UNK
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


Changed on 7/7/2013

VAERS ID: 38816 Before After
VAERS Form:
Age:81.3
Sex:Male
Location:Nevada
Vaccinated:1991-11-26
Onset:1991-12-18
Submitted:1992-01-07
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 0 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myalgia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-18
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: UNK
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


Changed on 2/14/2017

VAERS ID: 38816 Before After
VAERS Form:
Age:81.3 81.0
Sex:Male
Location:Nevada
Vaccinated:1991-11-26
Onset:1991-12-18
Submitted:1992-01-07
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 0 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myalgia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-18
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: UNK
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


Changed on 5/14/2017

VAERS ID: 38816 Before After
VAERS Form:
Age:81.0
Sex:Male
Location:Nevada
Vaccinated:1991-11-26
Onset:1991-12-18
Submitted:1992-01-07
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 0 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myalgia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-18
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: UNK UNK~ ()~~~In patient
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


Changed on 9/14/2017

VAERS ID: 38816 Before After
VAERS Form:(blank) 1
Age:81.0
Sex:Male
Location:Nevada
Vaccinated:1991-11-26
Onset:1991-12-18
Submitted:1992-01-07
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 0 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myalgia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-18
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: UNK~ ()~~~In patient
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


Changed on 2/14/2018

VAERS ID: 38816 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Nevada
Vaccinated:1991-11-26
Onset:1991-12-18
Submitted:1992-01-07
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myalgia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-18
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: UNK~ ()~~~In patient
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


Changed on 6/14/2018

VAERS ID: 38816 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Nevada
Vaccinated:1991-11-26
Onset:1991-12-18
Submitted:1992-01-07
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myalgia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-18
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: UNK~ ()~~~In patient
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


Changed on 8/14/2018

VAERS ID: 38816 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Nevada
Vaccinated:1991-11-26
Onset:1991-12-18
Submitted:1992-01-07
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myalgia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-18
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: UNK~ ()~~~In patient
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


Changed on 9/14/2018

VAERS ID: 38816 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Nevada
Vaccinated:1991-11-26
Onset:1991-12-18
Submitted:1992-01-07
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myalgia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-18
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: UNK~ ()~~~In patient
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;


Changed on 10/14/2018

VAERS ID: 38816 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Nevada
Vaccinated:1991-11-26
Onset:1991-12-18
Submitted:1992-01-07
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Myalgia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-18
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: UNK~ ()~~~In patient
Other Medications: Home 02 therapy; voltaren 75 mg BID;
Current Illness: COPD
Preexisting Conditions: CHF, COPD
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV92001

Write-up: C/o muscular ache 2 days p/immun relieved of aches p/5 days; no c/o of other rxn when followed-up on 2DEC91; cardio-pulmonary arrest 18DEC91 @ 120PM; death certificate not available for review, as yet;

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