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This is VAERS ID 413836

History of Changes from the VAERS Wayback Machine

First Appeared on 1/4/2011

VAERS ID: 413836
VAERS Form:
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (NO BRAND NAME 10-11) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 3/11/2011

VAERS ID: 413836 Before After
VAERS Form:
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (NO BRAND NAME 10-11) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00 2011-01-07
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? Yes, days: 5 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 4/13/2011

VAERS ID: 413836 Before After
VAERS Form:
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (NO BRAND NAME 10-11) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abnormal loss of weight, Acute promyelocytic leukaemia, Blood calcium decreased, Blood creatinine increased, Blood fibrinogen decreased, Blood product transfusion, Blood urea increased, Cardiac murmur, Chromosome analysis abnormal, Coloboma, Death, Disseminated intravascular coagulation, Dizziness, Ecchymosis, Endoscopy upper gastrointestinal tract abnormal, Fatigue, Full blood count normal, Gastrointestinal haemorrhage, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin decreased, International normalised ratio decreased, International normalised ratio increased, Melaena, Nausea, Pancytopenia, Peripheral ischaemia, Platelet count decreased, Renal failure acute, Syncope, Thrombocytopenia, White blood cell count decreased, Oesophagogastroduodenoscopy, Computerised tomogram abdomen abnormal, Arcus lipoides, Extremity necrosis, Palliative care, Blood smear test abnormal, Decreased appetite, Fluorescent in situ hybridisation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 5/13/2011

VAERS ID: 413836 Before After
VAERS Form:
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (NO BRAND NAME 10-11) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abnormal loss of weight, Acute promyelocytic leukaemia, Blood calcium decreased, Blood creatinine increased, Blood fibrinogen decreased, Blood product transfusion, Blood urea increased, Cardiac murmur, Chromosome analysis abnormal, Coloboma, Death, Disseminated intravascular coagulation, Dizziness, Ecchymosis, Endoscopy upper gastrointestinal tract abnormal, Fatigue, Full blood count normal, Gastrointestinal haemorrhage, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin decreased, International normalised ratio decreased, International normalised ratio increased, Melaena, Nausea, Pancytopenia, Peripheral ischaemia, Platelet count decreased, Renal failure acute, Syncope, Thrombocytopenia, White blood cell count decreased, Oesophagogastroduodenoscopy, Computerised tomogram abdomen abnormal, Arcus lipoides, Extremity necrosis, Palliative care, Blood smear test abnormal, Decreased appetite, Fluorescent in situ hybridisation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 7/12/2011

VAERS ID: 413836 Before After
VAERS Form:
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
FLU(10-11): INFLUENZA (SEASONAL) (NO BRAND NAME 10-11) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 7/7/2013

VAERS ID: 413836 Before After
VAERS Form:
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 6/14/2014

VAERS ID: 413836 Before After
VAERS Form:
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 12/14/2016

VAERS ID: 413836 Before After
VAERS Form:
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 4/14/2017

VAERS ID: 413836 Before After
VAERS Form:
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 9/14/2017

VAERS ID: 413836 Before After
VAERS Form:(blank) 1
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 2/14/2018

VAERS ID: 413836 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 6/14/2018

VAERS ID: 413836 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 8/14/2018

VAERS ID: 413836 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 9/14/2018

VAERS ID: 413836 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 10/14/2018

VAERS ID: 413836 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 12/24/2020

VAERS ID: 413836 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 12/30/2020

VAERS ID: 413836 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 5/7/2021

VAERS ID: 413836 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.


Changed on 5/14/2021

VAERS ID: 413836 Before After
VAERS Form:1
Age:95.0
Sex:Female
Location:Minnesota
Vaccinated:2010-11-01
Onset:2010-12-20
Submitted:2011-01-02
Entered:2011-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count normal, Haemoglobin decreased, International normalised ratio decreased, Melaena, Nausea, Platelet count decreased, White blood cell count decreased, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-07
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril; Aspirin; Omeprazole; Diltiazem
Current Illness: None
Preexisting Conditions: Hypertension; Chronic kidney disease; Neurogenic bladder; Allergies: codeine, sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: May of 2010, CBC plt were normal. Dec of 2010, WBC count of 2.5 - hemoglobin = 7.0 - plt = 14 - no schistocystes or RBC fragments to suggest consumptive coagulopathy, no teardrop cells, plts appear nl, INR = 1.29. Patient complaining of melanic stools, abdominal pain, nauseam decreased appetite, for since December 20, 2010.

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