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This is VAERS ID 405951

History of Changes from the VAERS Wayback Machine

First Appeared on 11/3/2010

VAERS ID: 405951
VAERS Form:
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR U3650AA / 0 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 12/7/2010

VAERS ID: 405951 Before After
VAERS Form:
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR U3650AA / 0 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 1/4/2011

VAERS ID: 405951 Before After
VAERS Form:
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR U3650AA / 0 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 4/13/2011

VAERS ID: 405951 Before After
VAERS Form:
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR U3650AA / 0 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Arteriosclerosis, Death, Headache, Hypertensive heart disease, Oedema peripheral, Pain in extremity, Toxicologic test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 5/13/2011

VAERS ID: 405951 Before After
VAERS Form:
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR U3650AA / 0 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Arteriosclerosis, Death, Headache, Hypertensive heart disease, Oedema peripheral, Pain in extremity, Toxicologic test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 7/12/2011

VAERS ID: 405951 Before After
VAERS Form:
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 0 UN / IM
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR U3650AA / 0 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 7/7/2013

VAERS ID: 405951 Before After
VAERS Form:
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 0 UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 0 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 9/14/2017

VAERS ID: 405951 Before After
VAERS Form:(blank) 1
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 0 1 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 2/14/2018

VAERS ID: 405951 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 1 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 6/14/2018

VAERS ID: 405951 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 1 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 8/14/2018

VAERS ID: 405951 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 1 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 9/14/2018

VAERS ID: 405951 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 1 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 10/14/2018

VAERS ID: 405951 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 1 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 12/24/2020

VAERS ID: 405951 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 1 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 12/30/2020

VAERS ID: 405951 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 1 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 5/7/2021

VAERS ID: 405951 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 1 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms


Changed on 5/14/2021

VAERS ID: 405951 Before After
VAERS Form:1
Age:22.0
Sex:Male
Location:New York
Vaccinated:2010-10-26
Onset:2010-10-27
Submitted:2010-10-29
Entered:2010-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3650AA / 1 UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Headache, Oedema peripheral, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-28
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:
Other Medications:
Current Illness: None Reported
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: HEADACHE, Swolen painful arms

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=405951&WAYBACKHISTORY=ON


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