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This is VAERS ID 465916

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2012

VAERS ID: 465916
VAERS Form:
Age:81.0
Sex:Male
Location:Texas
Vaccinated:2012-09-20
Onset:2012-09-21
Submitted:2012-09-21
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4494AA / - UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Faecal incontinence, Pain, Activities of daily living impaired, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-21
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:
Other Medications: Losartan 50mg daily
Current Illness: No chronic disease noted
Preexisting Conditions: Diabetes; Hypertension
Allergies:
Diagnostic Lab Data: Since flu vaccine was adminstered within such a close timeframe, medical examiner thought that we should be aware and report to VAERS, the possible link of the vaccine to the patient''s death.
CDC 'Split Type':

Write-up: Patient complained of "achiness" around 2:30 to 3:00 pm. His symptoms progressed to stiffness and soreness by bedtime and needed help with his clothing before bed. Around Midnight, there was a loss of bowel control and he passed away.


Changed on 7/7/2013

VAERS ID: 465916 Before After
VAERS Form:
Age:81.0
Sex:Male
Location:Texas
Vaccinated:2012-09-20
Onset:2012-09-21
Submitted:2012-09-21
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4494AA / - UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4494AA / - UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Faecal incontinence, Pain, Activities of daily living impaired, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-21
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:
Other Medications: Losartan 50mg daily
Current Illness: No chronic disease noted
Preexisting Conditions: Diabetes; Hypertension
Allergies:
Diagnostic Lab Data: Since flu vaccine was adminstered within such a close timeframe, medical examiner thought that we should be aware and report to VAERS, the possible link of the vaccine to the patient''s death.
CDC 'Split Type':

Write-up: Patient complained of "achiness" around 2:30 to 3:00 pm. His symptoms progressed to stiffness and soreness by bedtime and needed help with his clothing before bed. Around Midnight, there was a loss of bowel control and he passed away.


Changed on 6/14/2014

VAERS ID: 465916 Before After
VAERS Form:
Age:81.0
Sex:Male
Location:Texas
Vaccinated:2012-09-20
Onset:2012-09-21
Submitted:2012-09-21
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4494AA / - UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Faecal incontinence, Pain, Activities of daily living impaired, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-21
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:
Other Medications: Losartan 50mg daily
Current Illness: No chronic disease noted
Preexisting Conditions: Diabetes; Hypertension
Allergies:
Diagnostic Lab Data: Since flu vaccine was adminstered within such a close timeframe, medical examiner thought that we should be aware and report to VAERS, the possible link of the vaccine to the patient''s death.
CDC 'Split Type':

Write-up: Patient complained of "achiness" around 2:30 to 3:00 pm. His symptoms progressed to stiffness and soreness by bedtime and needed help with his clothing before bed. Around Midnight, there was a loss of bowel control and he passed away.


Changed on 3/14/2015

VAERS ID: 465916 Before After
VAERS Form:
Age:81.0
Sex:Male
Location:Texas
Vaccinated:2012-09-20
Onset:2012-09-21
Submitted:2012-09-21
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4494AA / - UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Faecal incontinence, Pain, Activities of daily living impaired, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-21
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:
Other Medications: Losartan 50mg daily
Current Illness: No chronic disease noted
Preexisting Conditions: Diabetes; Hypertension
Allergies:
Diagnostic Lab Data: Since flu vaccine was adminstered within such a close timeframe, medical examiner thought that we should be aware and report to VAERS, the possible link of the vaccine to the patient''s death.
CDC 'Split Type':

Write-up: Patient complained of "achiness" around 2:30 to 3:00 pm. His symptoms progressed to stiffness and soreness by bedtime and needed help with his clothing before bed. Around Midnight, there was a loss of bowel control and he passed away.


Changed on 9/14/2017

VAERS ID: 465916 Before After
VAERS Form:(blank) 1
Age:81.0
Sex:Male
Location:Texas
Vaccinated:2012-09-20
Onset:2012-09-21
Submitted:2012-09-21
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4494AA / - UNK UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Faecal incontinence, Pain, Activities of daily living impaired, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-21
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:
Other Medications: Losartan 50mg daily
Current Illness: No chronic disease noted
Preexisting Conditions: Diabetes; Hypertension
Allergies:
Diagnostic Lab Data: Since flu vaccine was adminstered within such a close timeframe, medical examiner thought that we should be aware and report to VAERS, the possible link of the vaccine to the patient''s death.
CDC 'Split Type':

Write-up: Patient complained of "achiness" around 2:30 to 3:00 pm. His symptoms progressed to stiffness and soreness by bedtime and needed help with his clothing before bed. Around Midnight, there was a loss of bowel control and he passed away.


Changed on 2/14/2018

VAERS ID: 465916 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Texas
Vaccinated:2012-09-20
Onset:2012-09-21
Submitted:2012-09-21
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4494AA / UNK UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Faecal incontinence, Pain, Activities of daily living impaired, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-21
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:
Other Medications: Losartan 50mg daily
Current Illness: No chronic disease noted
Preexisting Conditions: Diabetes; Hypertension
Allergies:
Diagnostic Lab Data: Since flu vaccine was adminstered within such a close timeframe, medical examiner thought that we should be aware and report to VAERS, the possible link of the vaccine to the patient''s death.
CDC 'Split Type':

Write-up: Patient complained of "achiness" around 2:30 to 3:00 pm. His symptoms progressed to stiffness and soreness by bedtime and needed help with his clothing before bed. Around Midnight, there was a loss of bowel control and he passed away.


Changed on 6/14/2018

VAERS ID: 465916 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Texas
Vaccinated:2012-09-20
Onset:2012-09-21
Submitted:2012-09-21
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4494AA / UNK UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Faecal incontinence, Pain, Activities of daily living impaired, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-21
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:
Other Medications: Losartan 50mg daily
Current Illness: No chronic disease noted
Preexisting Conditions: Diabetes; Hypertension
Allergies:
Diagnostic Lab Data: Since flu vaccine was adminstered within such a close timeframe, medical examiner thought that we should be aware and report to VAERS, the possible link of the vaccine to the patient''s death.
CDC 'Split Type':

Write-up: Patient complained of "achiness" around 2:30 to 3:00 pm. His symptoms progressed to stiffness and soreness by bedtime and needed help with his clothing before bed. Around Midnight, there was a loss of bowel control and he passed away.


Changed on 8/14/2018

VAERS ID: 465916 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Texas
Vaccinated:2012-09-20
Onset:2012-09-21
Submitted:2012-09-21
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4494AA / UNK UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Faecal incontinence, Pain, Activities of daily living impaired, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-21
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:
Other Medications: Losartan 50mg daily
Current Illness: No chronic disease noted
Preexisting Conditions: Diabetes; Hypertension
Allergies:
Diagnostic Lab Data: Since flu vaccine was adminstered within such a close timeframe, medical examiner thought that we should be aware and report to VAERS, the possible link of the vaccine to the patient''s death.
CDC 'Split Type':

Write-up: Patient complained of "achiness" around 2:30 to 3:00 pm. His symptoms progressed to stiffness and soreness by bedtime and needed help with his clothing before bed. Around Midnight, there was a loss of bowel control and he passed away.


Changed on 9/14/2018

VAERS ID: 465916 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Texas
Vaccinated:2012-09-20
Onset:2012-09-21
Submitted:2012-09-21
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4494AA / UNK UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Faecal incontinence, Pain, Activities of daily living impaired, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-21
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:
Other Medications: Losartan 50mg daily
Current Illness: No chronic disease noted
Preexisting Conditions: Diabetes; Hypertension
Allergies:
Diagnostic Lab Data: Since flu vaccine was adminstered within such a close timeframe, medical examiner thought that we should be aware and report to VAERS, the possible link of the vaccine to the patient''s death.
CDC 'Split Type':

Write-up: Patient complained of "achiness" around 2:30 to 3:00 pm. His symptoms progressed to stiffness and soreness by bedtime and needed help with his clothing before bed. Around Midnight, there was a loss of bowel control and he passed away.


Changed on 10/14/2018

VAERS ID: 465916 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Texas
Vaccinated:2012-09-20
Onset:2012-09-21
Submitted:2012-09-21
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4494AA / UNK UN / IM

Administered by: Other      Purchased by: Public
Symptoms: Death, Faecal incontinence, Pain, Activities of daily living impaired, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-21
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:
Other Medications: Losartan 50mg daily
Current Illness: No chronic disease noted
Preexisting Conditions: Diabetes; Hypertension
Allergies:
Diagnostic Lab Data: Since flu vaccine was adminstered within such a close timeframe, medical examiner thought that we should be aware and report to VAERS, the possible link of the vaccine to the patient''s death.
CDC 'Split Type':

Write-up: Patient complained of "achiness" around 2:30 to 3:00 pm. His symptoms progressed to stiffness and soreness by bedtime and needed help with his clothing before bed. Around Midnight, there was a loss of bowel control and he passed away.

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