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This is VAERS ID 39281

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39281
VAERS Form:
Age:79.8
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918131 / 0 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: PNEUMONIA, PHARYNGITIS, INTEST PER

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


Changed on 12/8/2009

VAERS ID: 39281 Before After
VAERS Form:
Age:79.8
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-02-04 1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918131 / 0 LA / IM

Administered by: Public      Purchased by: Unknown Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia, PNEUMONIA, PHARYNGITIS, INTEST PER

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


Changed on 8/31/2010

VAERS ID: 39281 Before After
VAERS Form:
Age:79.8
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918131 / 0 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


Changed on 7/7/2013

VAERS ID: 39281 Before After
VAERS Form:
Age:79.8
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


Changed on 12/14/2016

VAERS ID: 39281 Before After
VAERS Form:
Age:79.8
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


Changed on 2/14/2017

VAERS ID: 39281 Before After
VAERS Form:
Age:79.8 79.0
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


Changed on 5/14/2017

VAERS ID: 39281 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


Changed on 9/14/2017

VAERS ID: 39281 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


Changed on 2/14/2018

VAERS ID: 39281 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


Changed on 6/14/2018

VAERS ID: 39281 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


Changed on 8/14/2018

VAERS ID: 39281 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


Changed on 9/14/2018

VAERS ID: 39281 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;


Changed on 10/14/2018

VAERS ID: 39281 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Wisconsin
Vaccinated:1991-11-13
Onset:1991-11-18
Submitted:1992-01-16
Entered:1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Intestinal perforation, Pharyngitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Comtrex, blood thinner, Imodium for diarrhea;
Current Illness: NONE
Preexisting Conditions: peripheral vascular
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 1/2 wk p/shot got sore throat Mon AM went to ER on Tues Evening 19NOV hospitalized pneumonia, perforated bowel; died;

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=39281&WAYBACKHISTORY=ON


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