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This is VAERS ID 44074

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 44074
VAERS Form:
Age:91.5
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918130 / 0 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: HYPOTENS, DYSPNEA, EDEMA LUNG, HEART ARREST, ARRHYTHMIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': UNK

Write-up: pt had a massive heart attack;


Changed on 12/8/2009

VAERS ID: 44074 Before After
VAERS Form:
Age:91.5
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-11 1992-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918130 / 0 RA / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia, HYPOTENS, DYSPNEA, EDEMA LUNG, HEART ARREST, ARRHYTHMIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': UNK CA9277

Write-up: pt had a massive heart attack;


Changed on 8/31/2010

VAERS ID: 44074 Before After
VAERS Form:
Age:91.5
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918130 / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': CA9277

Write-up: pt had a massive heart attack;


Changed on 7/7/2013

VAERS ID: 44074 Before After
VAERS Form:
Age:91.5
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 0 RA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': CA9277

Write-up: pt had a massive heart attack;


Changed on 12/14/2016

VAERS ID: 44074 Before After
VAERS Form:
Age:91.5
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 0 RA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': CA9277

Write-up: pt had a massive heart attack;


Changed on 2/14/2017

VAERS ID: 44074 Before After
VAERS Form:
Age:91.5 91.0
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': CA9277

Write-up: pt had a massive heart attack;


Changed on 5/14/2017

VAERS ID: 44074 Before After
VAERS Form:
Age:91.0
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': CA9277

Write-up: pt had a massive heart attack;


Changed on 9/14/2017

VAERS ID: 44074 Before After
VAERS Form:(blank) 1
Age:91.0
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 0 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': CA9277

Write-up: pt had a massive heart attack;


Changed on 2/14/2018

VAERS ID: 44074 Before After
VAERS Form:1
Age:91.0
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': CA9277

Write-up: pt had a massive heart attack;


Changed on 6/14/2018

VAERS ID: 44074 Before After
VAERS Form:1
Age:91.0
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': CA9277

Write-up: pt had a massive heart attack;


Changed on 8/14/2018

VAERS ID: 44074 Before After
VAERS Form:1
Age:91.0
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': CA9277

Write-up: pt had a massive heart attack;


Changed on 9/14/2018

VAERS ID: 44074 Before After
VAERS Form:1
Age:91.0
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': CA9277

Write-up: pt had a massive heart attack;


Changed on 10/14/2018

VAERS ID: 44074 Before After
VAERS Form:1
Age:91.0
Sex:Female
Location:California
Vaccinated:1991-11-14
Onset:1991-11-21
Submitted:1992-02-19
Entered:1992-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918130 / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Arrhythmia, Cardiac arrest, Dyspnoea, Hypotension, Myocardial infarction, Pulmonary oedema, Shock, Ventricular tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-11-21
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? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': CA9277

Write-up: pt had a massive heart attack;

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