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This is VAERS ID 414974

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2011

VAERS ID: 414974
VAERS Form:
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUHD(10-11): INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE 10-11) / SANOFI PASTEUR U3602AA / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 4/13/2011

VAERS ID: 414974 Before After
VAERS Form:
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUHD(10-11): INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE 10-11) / SANOFI PASTEUR U3602AA / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Acute myocardial infarction, Acute prerenal failure, Acute respiratory failure, Anaemia, Anxiety, Areflexia, Ascites, Blood culture positive, Cardiogenic shock, Cardiomegaly, Chest pain, Chest X-ray abnormal, Cholelithiasis, CSF culture negative, CSF protein normal, Death, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Extubation, Gallbladder disorder, Guillain-Barre syndrome, Hyponatraemia, Hypophosphataemia, Hypotension, Intensive care, Liver function test abnormal, Lumbar puncture, Malaise, Multi-organ failure, Muscular weakness, Myocardial infarction, Nausea, Osteoarthritis, Pericardial effusion, Plasmapheresis, Pleural effusion, Pyrexia, Sepsis, Septic shock, Splenomegaly, Vomiting, Left ventricular hypertrophy, CSF glucose increased, Sputum culture positive, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Klebsiella infection, Echocardiogram abnormal, Mechanical ventilation, Left atrial dilatation, Endotracheal intubation, Immunoglobulin therapy, Nuclear magnetic resonance imaging spinal cord abnormal, Antibiotic resistant Staphylococcus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 5/13/2011

VAERS ID: 414974 Before After
VAERS Form:
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUHD(10-11): INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE 10-11) / SANOFI PASTEUR U3602AA / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Acute myocardial infarction, Acute prerenal failure, Acute respiratory failure, Anaemia, Anxiety, Areflexia, Ascites, Blood culture positive, Cardiogenic shock, Cardiomegaly, Chest pain, Chest X-ray abnormal, Cholelithiasis, CSF culture negative, CSF protein normal, Death, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Electrocardiogram ST segment elevation, Extubation, Gallbladder disorder, Guillain-Barre syndrome, Hyponatraemia, Hypophosphataemia, Hypotension, Intensive care, Liver function test abnormal, Lumbar puncture, Malaise, Multi-organ failure, Muscular weakness, Myocardial infarction, Nausea, Osteoarthritis, Pericardial effusion, Plasmapheresis, Pleural effusion, Pyrexia, Sepsis, Septic shock, Splenomegaly, Vomiting, Left ventricular hypertrophy, CSF glucose increased, Sputum culture positive, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Klebsiella infection, Echocardiogram abnormal, Mechanical ventilation, Left atrial dilatation, Endotracheal intubation, Immunoglobulin therapy, Nuclear magnetic resonance imaging spinal cord abnormal, Antibiotic resistant Staphylococcus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 7/12/2011

VAERS ID: 414974 Before After
VAERS Form:
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 0 LA / IM
FLUHD(10-11): INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE 10-11) / SANOFI PASTEUR U3602AA / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 7/7/2013

VAERS ID: 414974 Before After
VAERS Form:
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 9/14/2017

VAERS ID: 414974 Before After
VAERS Form:(blank) 1
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 0 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 2/14/2018

VAERS ID: 414974 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 6/14/2018

VAERS ID: 414974 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 8/14/2018

VAERS ID: 414974 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 9/14/2018

VAERS ID: 414974 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 10/14/2018

VAERS ID: 414974 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 12/24/2020

VAERS ID: 414974 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 12/30/2020

VAERS ID: 414974 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 5/7/2021

VAERS ID: 414974 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.


Changed on 5/14/2021

VAERS ID: 414974 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Illinois
Vaccinated:2010-09-22
Onset:2010-12-26
Submitted:2011-01-19
Entered:2011-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U3602AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per patients daughter, he developed Guillain Barre Syndrome. He fell ill on 12/26/2010, was admitted to Medical Center and passed away on 1/6/2011.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=414974&WAYBACKHISTORY=ON


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