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This is VAERS ID 435707

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/11/2011

VAERS ID: 435707
VAERS Form:
Age:21.0
Sex:Male
Location:Washington
Vaccinated:2011-09-22
Onset:2011-09-25
Submitted:2011-09-26
Entered:2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 2 - / IN

Administered by: Military      Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-25
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: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC 'Split Type':

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.


Changed on 7/7/2013

VAERS ID: 435707 Before After
VAERS Form:
Age:21.0
Sex:Male
Location:Washington
Vaccinated:2011-09-22
Onset:2011-09-25
Submitted:2011-09-26
Entered:2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 2 - / IN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 2 - / IN

Administered by: Military      Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-25
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: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC 'Split Type':

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.


Changed on 9/14/2017

VAERS ID: 435707 Before After
VAERS Form:(blank) 1
Age:21.0
Sex:Male
Location:Washington
Vaccinated:2011-09-22
Onset:2011-09-25
Submitted:2011-09-26
Entered:2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 2 3 - NS / IN

Administered by: Military      Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-25
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: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC 'Split Type':

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.


Changed on 2/14/2018

VAERS ID: 435707 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Washington
Vaccinated:2011-09-22
Onset:2011-09-25
Submitted:2011-09-26
Entered:2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 3 NS / IN

Administered by: Military      Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-25
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: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC 'Split Type':

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.


Changed on 6/14/2018

VAERS ID: 435707 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Washington
Vaccinated:2011-09-22
Onset:2011-09-25
Submitted:2011-09-26
Entered:2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 3 NS / IN

Administered by: Military      Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-25
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: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC 'Split Type':

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.


Changed on 8/14/2018

VAERS ID: 435707 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Washington
Vaccinated:2011-09-22
Onset:2011-09-25
Submitted:2011-09-26
Entered:2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 3 NS / IN

Administered by: Military      Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-25
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: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC 'Split Type':

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.


Changed on 9/14/2018

VAERS ID: 435707 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Washington
Vaccinated:2011-09-22
Onset:2011-09-25
Submitted:2011-09-26
Entered:2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 3 NS / IN

Administered by: Military      Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-25
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: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC 'Split Type':

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.


Changed on 10/14/2018

VAERS ID: 435707 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Washington
Vaccinated:2011-09-22
Onset:2011-09-25
Submitted:2011-09-26
Entered:2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 3 NS / IN

Administered by: Military      Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-25
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: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC 'Split Type':

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.


Changed on 12/24/2020

VAERS ID: 435707 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Washington
Vaccinated:2011-09-22
Onset:2011-09-25
Submitted:2011-09-26
Entered:2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 3 NS / IN

Administered by: Military      Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-25
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: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC 'Split Type':

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.


Changed on 12/30/2020

VAERS ID: 435707 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Washington
Vaccinated:2011-09-22
Onset:2011-09-25
Submitted:2011-09-26
Entered:2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 3 NS / IN

Administered by: Military      Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-25
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: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC 'Split Type':

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.


Changed on 5/7/2021

VAERS ID: 435707 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Washington
Vaccinated:2011-09-22
Onset:2011-09-25
Submitted:2011-09-26
Entered:2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 3 NS / IN

Administered by: Military      Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-25
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: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC 'Split Type':

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.


Changed on 5/14/2021

VAERS ID: 435707 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Washington
Vaccinated:2011-09-22
Onset:2011-09-25
Submitted:2011-09-26
Entered:2011-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501096P / 3 NS / IN

Administered by: Military      Purchased by: Military
Symptoms: Chest pain, Death, Malaise, Resuscitation, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-25
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: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: Autopsy has been ordered
CDC 'Split Type':

Write-up: Member was given the Flumist on 09/22/2011. On 09/25/2011, member was feeling chest pain and not feeling well after dinner and going to the Club. Mamber was found down face in vomit by his friends. CPR was started and 911 activated. Paramedics arrived and continued CPR en route to Hospital where CPR was continued unsuccesfully. Member was pronounced dead at 0215 by Dr.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=435707&WAYBACKHISTORY=ON


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