National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 39743

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39743
VAERS Form:
Age:104
Sex:Female
Location:Hawaii
Vaccinated:1991-10-27
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 / - GM / IM

Administered by: Other      Purchased by: Unknown
Symptoms: APNEA, DEHYDRAT, HEART ARREST, BRONCHITIS, ARTERIOSCLEROSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-16
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: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


Changed on 12/8/2009

VAERS ID: 39743 Before After
VAERS Form:
Age:104
Sex:Female
Location:Hawaii
Vaccinated:1991-10-27
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 / - GM / IM

Administered by: Other Unknown      Purchased by: Unknown
Symptoms: Apnoea, Arteriosclerosis, Bronchitis, Cardiac arrest, Dehydration, APNEA, DEHYDRAT, HEART ARREST, BRONCHITIS, ARTERIOSCLEROSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-16
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~ ()~~0~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory; HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


Changed on 8/31/2010

VAERS ID: 39743 Before After
VAERS Form:
Age:104
Sex:Female
Location:Hawaii
Vaccinated:1991-10-27
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 / - GM / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Arteriosclerosis, Bronchitis, Cardiac arrest, Dehydration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-16
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~ ()~~0~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


Changed on 7/7/2013

VAERS ID: 39743 Before After
VAERS Form:
Age:104
Sex:Female
Location:Hawaii
Vaccinated:1991-10-27
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 / - GM / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / - GM / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Arteriosclerosis, Bronchitis, Cardiac arrest, Dehydration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-16
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~ ()~~0~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


Changed on 12/14/2016

VAERS ID: 39743 Before After
VAERS Form:
Age:104
Sex:Female
Location:Hawaii
Vaccinated:1991-10-27
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 / - GM / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / - GM / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Arteriosclerosis, Bronchitis, Cardiac arrest, Dehydration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-16
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~ ()~~0~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


Changed on 5/14/2017

VAERS ID: 39743 Before After
VAERS Form:
Age:104 104.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-27
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 / - GM / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Arteriosclerosis, Bronchitis, Cardiac arrest, Dehydration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-16
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~ ()~~0~In ()~~0.00~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


Changed on 9/14/2017

VAERS ID: 39743 Before After
VAERS Form:(blank) 1
Age:104.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-27
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 GM / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Arteriosclerosis, Bronchitis, Cardiac arrest, Dehydration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-16
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~ ()~~0.00~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


Changed on 2/14/2018

VAERS ID: 39743 Before After
VAERS Form:1
Age:104.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-27
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 GM / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Arteriosclerosis, Bronchitis, Cardiac arrest, Dehydration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-16
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~ ()~~0.00~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


Changed on 6/14/2018

VAERS ID: 39743 Before After
VAERS Form:1
Age:104.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-27
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 GM / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Arteriosclerosis, Bronchitis, Cardiac arrest, Dehydration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-16
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~ ()~~0.00~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


Changed on 8/14/2018

VAERS ID: 39743 Before After
VAERS Form:1
Age:104.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-27
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 GM / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Arteriosclerosis, Bronchitis, Cardiac arrest, Dehydration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-16
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~ ()~~0.00~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


Changed on 9/14/2018

VAERS ID: 39743 Before After
VAERS Form:1
Age:104.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-27
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 GM / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Arteriosclerosis, Bronchitis, Cardiac arrest, Dehydration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-16
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~ ()~~0.00~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;


Changed on 10/14/2018

VAERS ID: 39743 Before After
VAERS Form:1
Age:104.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-27
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 GM / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Arteriosclerosis, Bronchitis, Cardiac arrest, Dehydration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-16
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~ ()~~0.00~In Patient
Other Medications: Dulcolax, APAP, MOM, Synthroid, Colase, MVI, CA supplement, Cipro;
Current Illness: pneumonia, malnutrition, s/p femur fract
Preexisting Conditions: NKA, alzheimer''s dementia, chronic dermatitis, HTN, osteoporosis, osteoarthritis, hypothyroidism, incontinent, fragil skin w/some tears, poor appetite, & non ambulatory;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9203

Write-up: Adm dx: ORIF-rt supracondylar fracture, gastric ulcer; final dx cardiorespiratory arrest, acute bronchitis, demantia-alzheimer''s type, secondary dx malnutrition, dehydrat, ASCVD, osteoporosis, osteoarthritis;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=39743&WAYBACKHISTORY=ON


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