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This is VAERS ID 42220

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 42220
VAERS Form:
Age:64.0
Sex:Male
Location:Wyoming
Vaccinated:1991-10-18
Onset:1991-10-21
Submitted:1991-10-22
Entered:1992-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1991-1992 EVANS MED & LEDERLE / LEDERLE 314964 / 1 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-21
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: NONE
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': denied allergy to eggs, mercury; heart & lungs diseases history;

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


Changed on 12/8/2009

VAERS ID: 42220 Before After
VAERS Form:
Age:64.0
Sex:Male
Location:Wyoming
Vaccinated:1991-10-18
Onset:1991-10-21
Submitted:1991-10-22
Entered:1992-06-02 1992-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1991-1992 EVANS MED & LEDERLE INFLUENZA (SEASONAL) (FLU-IMUNE 91-92) / LEDERLE LEDERLE LABORATORIES 314964 / 1 LA / IM

Administered by: Other      Purchased by: Unknown Public
Symptoms: Apnoea, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-21
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: NONE
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': denied allergy to eggs, mercury; heart & lungs diseases history; WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


Changed on 8/31/2010

VAERS ID: 42220 Before After
VAERS Form:
Age:64.0
Sex:Male
Location:Wyoming
Vaccinated:1991-10-18
Onset:1991-10-21
Submitted:1991-10-22
Entered:1992-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE 91-92) INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-21
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: NONE
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


Changed on 7/7/2013

VAERS ID: 42220 Before After
VAERS Form:
Age:64.0
Sex:Male
Location:Wyoming
Vaccinated:1991-10-18
Onset:1991-10-21
Submitted:1991-10-22
Entered:1992-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 1 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-21
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: NONE
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


Changed on 5/14/2017

VAERS ID: 42220 Before After
VAERS Form:
Age:64.0
Sex:Male
Location:Wyoming
Vaccinated:1991-10-18
Onset:1991-10-21
Submitted:1991-10-22
Entered:1992-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-21
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: NONE NONE~ ()~~~In patient
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


Changed on 9/14/2017

VAERS ID: 42220 Before After
VAERS Form:(blank) 1
Age:64.0
Sex:Male
Location:Wyoming
Vaccinated:1991-10-18
Onset:1991-10-21
Submitted:1991-10-22
Entered:1992-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 1 2 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-21
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: NONE~ ()~~~In patient
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


Changed on 2/14/2018

VAERS ID: 42220 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Wyoming
Vaccinated:1991-10-18
Onset:1991-10-21
Submitted:1991-10-22
Entered:1992-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 2 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-21
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: NONE~ ()~~~In patient
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


Changed on 6/14/2018

VAERS ID: 42220 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Wyoming
Vaccinated:1991-10-18
Onset:1991-10-21
Submitted:1991-10-22
Entered:1992-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 2 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-21
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: NONE~ ()~~~In patient
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


Changed on 8/14/2018

VAERS ID: 42220 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Wyoming
Vaccinated:1991-10-18
Onset:1991-10-21
Submitted:1991-10-22
Entered:1992-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 2 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-21
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: NONE~ ()~~~In patient
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


Changed on 9/14/2018

VAERS ID: 42220 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Wyoming
Vaccinated:1991-10-18
Onset:1991-10-21
Submitted:1991-10-22
Entered:1992-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 2 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-21
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: NONE~ ()~~~In patient
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;


Changed on 10/14/2018

VAERS ID: 42220 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Wyoming
Vaccinated:1991-10-18
Onset:1991-10-21
Submitted:1991-10-22
Entered:1992-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 314964 / 2 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-21
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: NONE~ ()~~~In patient
Other Medications: UNK
Current Illness: denied any
Preexisting Conditions: denied allergy to eggs, mercury; heart & lungs diseases history;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': WY9115

Write-up: No s/s of rxn known about; pt gurgled in sleep, pronounced dead @ hosp;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=42220&WAYBACKHISTORY=ON


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