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This is VAERS ID 46704

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 46704
VAERS Form:
Age:64.0
Sex:Female
Location:Pennsylvania
Vaccinated:1992-10-02
Onset:1992-10-03
Submitted:1992-10-08
Entered:1992-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1992-1993 / PARKE-DAVIS 01272P / - - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type':

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


Changed on 12/8/2009

VAERS ID: 46704 Before After
VAERS Form:
Age:64.0
Sex:Female
Location:Pennsylvania
Vaccinated:1992-10-02
Onset:1992-10-03
Submitted:1992-10-08
Entered:1992-11-06 1992-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1992-1993 INFLUENZA (SEASONAL) (FLUOGEN 92-93) / PARKE-DAVIS 01272P / - - / IM

Administered by: Public      Purchased by: Unknown Other
Symptoms: Cardiac arrest, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': (blank) 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


Changed on 8/31/2010

VAERS ID: 46704 Before After
VAERS Form:
Age:64.0
Sex:Female
Location:Pennsylvania
Vaccinated:1992-10-02
Onset:1992-10-03
Submitted:1992-10-08
Entered:1992-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 92-93) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / - - / IM

Administered by: Public      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


Changed on 7/7/2013

VAERS ID: 46704 Before After
VAERS Form:
Age:64.0
Sex:Female
Location:Pennsylvania
Vaccinated:1992-10-02
Onset:1992-10-03
Submitted:1992-10-08
Entered:1992-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / - - / IM

Administered by: Public      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


Changed on 5/14/2017

VAERS ID: 46704 Before After
VAERS Form:
Age:64.0
Sex:Female
Location:Pennsylvania
Vaccinated:1992-10-02
Onset:1992-10-03
Submitted:1992-10-08
Entered:1992-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / - - / IM

Administered by: Public      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


Changed on 9/14/2017

VAERS ID: 46704 Before After
VAERS Form:(blank) 1
Age:64.0
Sex:Female
Location:Pennsylvania
Vaccinated:1992-10-02
Onset:1992-10-03
Submitted:1992-10-08
Entered:1992-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / - UNK - / IM

Administered by: Public      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


Changed on 2/14/2018

VAERS ID: 46704 Before After
VAERS Form:1
Age:64.0
Sex:Female
Location:Pennsylvania
Vaccinated:1992-10-02
Onset:1992-10-03
Submitted:1992-10-08
Entered:1992-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

Administered by: Public      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


Changed on 6/14/2018

VAERS ID: 46704 Before After
VAERS Form:1
Age:64.0
Sex:Female
Location:Pennsylvania
Vaccinated:1992-10-02
Onset:1992-10-03
Submitted:1992-10-08
Entered:1992-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

Administered by: Public      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


Changed on 8/14/2018

VAERS ID: 46704 Before After
VAERS Form:1
Age:64.0
Sex:Female
Location:Pennsylvania
Vaccinated:1992-10-02
Onset:1992-10-03
Submitted:1992-10-08
Entered:1992-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

Administered by: Public      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


Changed on 9/14/2018

VAERS ID: 46704 Before After
VAERS Form:1
Age:64.0
Sex:Female
Location:Pennsylvania
Vaccinated:1992-10-02
Onset:1992-10-03
Submitted:1992-10-08
Entered:1992-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

Administered by: Public      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;


Changed on 10/14/2018

VAERS ID: 46704 Before After
VAERS Form:1
Age:64.0
Sex:Female
Location:Pennsylvania
Vaccinated:1992-10-02
Onset:1992-10-03
Submitted:1992-10-08
Entered:1992-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01272P / UNK - / IM

Administered by: Public      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: n/s
Current Illness: n/s
Preexisting Conditions: n/s
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 924092014

Write-up: death is reported in a pt who recvd 1 dose of flu vax 2OCT; pt died in sleep on 3OCT; coroner stated that there was no evidence of swelling or anaphylaxis & believed that pt died in sleep of natural causes or a coronary;

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=46704&WAYBACKHISTORY=ON


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