National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 39745

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39745
VAERS Form:
Age:75.4
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


Changed on 12/8/2009

VAERS ID: 39745 Before After
VAERS Form:
Age:75.4
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 / - - / IM

Administered by: Other      Purchased by: Unknown Public
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion; HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


Changed on 8/31/2010

VAERS ID: 39745 Before After
VAERS Form:
Age:75.4
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 / - - / IM

Administered by: Other      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


Changed on 7/7/2013

VAERS ID: 39745 Before After
VAERS Form:
Age:75.4
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 / - - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / - - / IM

Administered by: Other      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


Changed on 12/14/2016

VAERS ID: 39745 Before After
VAERS Form:
Age:75.4
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 / - - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918147 / - - / IM

Administered by: Other      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


Changed on 2/14/2017

VAERS ID: 39745 Before After
VAERS Form:
Age:75.4 75.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 / - - / IM

Administered by: Other      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


Changed on 5/14/2017

VAERS ID: 39745 Before After
VAERS Form:
Age:75.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 / - - / IM

Administered by: Other      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


Changed on 9/14/2017

VAERS ID: 39745 Before After
VAERS Form:(blank) 1
Age:75.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 - / IM

Administered by: Other      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


Changed on 2/14/2018

VAERS ID: 39745 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 - / IM

Administered by: Other      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


Changed on 6/14/2018

VAERS ID: 39745 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 - / IM

Administered by: Other      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


Changed on 8/14/2018

VAERS ID: 39745 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 - / IM

Administered by: Other      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


Changed on 9/14/2018

VAERS ID: 39745 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 - / IM

Administered by: Other      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;


Changed on 10/14/2018

VAERS ID: 39745 Before After
VAERS Form:1
Age:75.0
Sex:Female
Location:Hawaii
Vaccinated:1991-10-29
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 - / IM

Administered by: Other      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-05
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: Zantac, fortax, digoxin, theophylline, solu-medrol, Capoten, Lasix;
Current Illness: Pneumonia, COPD;
Preexisting Conditions: Allergic to crab, shrimp, lobster; COPD, cardiomyopathy, hx HTN, degenerative joint dis, CHF; resp status secondary to pneumonia & pulmonary congestion;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': HI9205

Write-up: adm dx dilated cardiomyopathy; COPD, chronic CHF, hx HTN,DJD; pt died 5NOV91;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=39745&WAYBACKHISTORY=ON


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