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This is VAERS ID 39014

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39014
VAERS Form:
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:1991-11-12
Onset:1991-12-10
Submitted:0000-00-00
Entered:1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 / PARKE-DAVIS - / - A / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: STUPOR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-15
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: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


Changed on 12/8/2009

VAERS ID: 39014 Before After
VAERS Form:
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:1991-11-12
Onset:1991-12-10
Submitted:0000-00-00
Entered:1992-01-24 1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 INFLUENZA (SEASONAL) (FLUOGEN 91-92) / PARKE-DAVIS - / - A / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Stupor, STUPOR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-15
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: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


Changed on 8/31/2010

VAERS ID: 39014 Before After
VAERS Form:
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:1991-11-12
Onset:1991-12-10
Submitted:0000-00-00
Entered:1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 91-92) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - A / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-15
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: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


Changed on 7/7/2013

VAERS ID: 39014 Before After
VAERS Form:
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:1991-11-12
Onset:1991-12-10
Submitted:0000-00-00
Entered:1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - A / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - A / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-15
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: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


Changed on 5/14/2017

VAERS ID: 39014 Before After
VAERS Form:
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:1991-11-12
Onset:1991-12-10
Submitted:0000-00-00
Entered:1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - A - / IM IM A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-15
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: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


Changed on 9/14/2017

VAERS ID: 39014 Before After
VAERS Form:(blank) 1
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:1991-11-12
Onset:1991-12-10
Submitted:0000-00-00
Entered:1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - UNK - / IM A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-15
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: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


Changed on 2/14/2018

VAERS ID: 39014 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:1991-11-12
Onset:1991-12-10
Submitted:0000-00-00
Entered:1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-15
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: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


Changed on 6/14/2018

VAERS ID: 39014 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:1991-11-12
Onset:1991-12-10
Submitted:0000-00-00
Entered:1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-15
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: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


Changed on 8/14/2018

VAERS ID: 39014 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:1991-11-12
Onset:1991-12-10
Submitted:0000-00-00
Entered:1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-15
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: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


Changed on 9/14/2018

VAERS ID: 39014 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:1991-11-12
Onset:1991-12-10
Submitted:0000-00-00
Entered:1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-15
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: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;


Changed on 10/14/2018

VAERS ID: 39014 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Unknown
Vaccinated:1991-11-12
Onset:1991-12-10
Submitted:0000-00-00
Entered:1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-15
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: Lasix, SYnthroid, FESO4, Vitamin C, APAP
Current Illness:
Preexisting Conditions: ASHD, CHF, hypothyroidisim, anemia, OBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approx 1 mo p/recvd flu vax, resident became difficult to arouse, verbally unresponsive 10DEC91 pt gradually improved 11DEC-14DEC91 then worsened on 15DEC91 & expired;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=39014&WAYBACKHISTORY=ON


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