National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 39742

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39742
VAERS Form:
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted:1991-11-25
Entered:1992-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918147 / - RA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: SEPSIS, SHOCK, INFECT URIN TRACT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


Changed on 12/8/2009

VAERS ID: 39742 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted:1991-11-25
Entered:1992-03-04 1992-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918147 / - RA / IM

Administered by: Other      Purchased by: Unknown Public
Symptoms: Sepsis, Shock, Urinary tract infection, SEPSIS, SHOCK, INFECT URIN TRACT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite; HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


Changed on 8/31/2010

VAERS ID: 39742 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted:1991-11-25
Entered:1992-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918147 / - RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


Changed on 7/7/2013

VAERS ID: 39742 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted:1991-11-25
Entered:1992-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / - RA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / - RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


Changed on 12/14/2016

VAERS ID: 39742 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted:1991-11-25
Entered:1992-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / - RA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / - RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


Changed on 5/14/2017

VAERS ID: 39742 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted:1991-11-25
Entered:1992-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / - RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


Changed on 9/14/2017

VAERS ID: 39742 Before After
VAERS Form:(blank) 1
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted:1991-11-25
Entered:1992-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / - UNK RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


Changed on 2/14/2018

VAERS ID: 39742 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted:1991-11-25
Entered:1992-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


Changed on 6/14/2018

VAERS ID: 39742 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted:1991-11-25
Entered:1992-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


Changed on 8/14/2018

VAERS ID: 39742 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted:1991-11-25
Entered:1992-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


Changed on 9/14/2018

VAERS ID: 39742 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted:1991-11-25
Entered:1992-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;


Changed on 10/14/2018

VAERS ID: 39742 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-22
Onset:0000-00-00
Submitted:1991-11-25
Entered:1992-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / UNK RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Sepsis, Shock, Urinary tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-09
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: APAP, Dulcolax, MOM, Theodur
Current Illness: COPD, rt femoral neck fracture, pneumoni
Preexisting Conditions: NKA; hx bilat pneumonia, COPD, hx hepatitis 1983, cataracts 1977, confusion, disorientation, incontinent, poor appetite;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9202

Write-up: Provisional admission dx COPD, s/p rt femoral neck fracture; since prior vax, pt had been deteriorating clinically (intermittent confusion, disorientation, incontinent, poor appetite); final dx septic shock, UTI; pt died 9NOV91;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=39742&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166