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This is VAERS ID 39744

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39744
VAERS Form:
Age:92.0
Sex:Male
Location:Hawaii
Vaccinated:1991-10-28
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: CEREBROVASC ACCID

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


Changed on 12/8/2009

VAERS ID: 39744 Before After
VAERS Form:
Age:92.0
Sex:Male
Location:Hawaii
Vaccinated:1991-10-28
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: Cerebrovascular accident, CEREBROVASC ACCID

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA; HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


Changed on 8/31/2010

VAERS ID: 39744 Before After
VAERS Form:
Age:92.0
Sex:Male
Location:Hawaii
Vaccinated:1991-10-28
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: Cerebrovascular accident

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


Changed on 7/7/2013

VAERS ID: 39744 Before After
VAERS Form:
Age:92.0
Sex:Male
Location:Hawaii
Vaccinated:1991-10-28
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: Cerebrovascular accident

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


Changed on 12/14/2016

VAERS ID: 39744 Before After
VAERS Form:
Age:92.0
Sex:Male
Location:Hawaii
Vaccinated:1991-10-28
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: Cerebrovascular accident

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


Changed on 5/14/2017

VAERS ID: 39744 Before After
VAERS Form:
Age:92.0
Sex:Male
Location:Hawaii
Vaccinated:1991-10-28
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: Cerebrovascular accident

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


Changed on 9/14/2017

VAERS ID: 39744 Before After
VAERS Form:(blank) 1
Age:92.0
Sex:Male
Location:Hawaii
Vaccinated:1991-10-28
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: Cerebrovascular accident

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


Changed on 2/14/2018

VAERS ID: 39744 Before After
VAERS Form:1
Age:92.0
Sex:Male
Location:Hawaii
Vaccinated:1991-10-28
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: Cerebrovascular accident

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


Changed on 6/14/2018

VAERS ID: 39744 Before After
VAERS Form:1
Age:92.0
Sex:Male
Location:Hawaii
Vaccinated:1991-10-28
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: Cerebrovascular accident

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


Changed on 8/14/2018

VAERS ID: 39744 Before After
VAERS Form:1
Age:92.0
Sex:Male
Location:Hawaii
Vaccinated:1991-10-28
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: Cerebrovascular accident

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


Changed on 9/14/2018

VAERS ID: 39744 Before After
VAERS Form:1
Age:92.0
Sex:Male
Location:Hawaii
Vaccinated:1991-10-28
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: Cerebrovascular accident

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;


Changed on 10/14/2018

VAERS ID: 39744 Before After
VAERS Form:1
Age:92.0
Sex:Male
Location:Hawaii
Vaccinated:1991-10-28
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: Cerebrovascular accident

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-08
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: Ceclor, Pseudoephedrine
Current Illness: CVA w/progressive dementia, rt lobe pne
Preexisting Conditions: chronic cerebral ischemia w/progressive dementia, hx UTI, anemia of chronic disease, very lethargic, poor appetite; NKA;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': HI9204

Write-up: adm dx rt lower lob pneumonia; final dx pneumonia, cerebrovascular accident; pt died 8NOV91;

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