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This is VAERS ID 467090

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2012

VAERS ID: 467090
VAERS Form:
Age:79.0
Sex:Male
Location:Missouri
Vaccinated:2012-09-24
Onset:2012-09-24
Submitted:2012-10-01
Entered:2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58406 / - - / IM

Administered by: Other      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-28
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: unknown
Current Illness: None
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: unknown.
CDC 'Split Type':

Write-up: Pt daughter reported next day that explosive diarrhea occurred. Recommended ER or urgent care.


Changed on 7/7/2013

VAERS ID: 467090 Before After
VAERS Form:
Age:79.0
Sex:Male
Location:Missouri
Vaccinated:2012-09-24
Onset:2012-09-24
Submitted:2012-10-01
Entered:2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58406 / - - / IM
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58406 / - - / IM

Administered by: Other      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-28
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: unknown
Current Illness: None
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: unknown.
CDC 'Split Type':

Write-up: Pt daughter reported next day that explosive diarrhea occurred. Recommended ER or urgent care.


Changed on 6/14/2014

VAERS ID: 467090 Before After
VAERS Form:
Age:79.0
Sex:Male
Location:Missouri
Vaccinated:2012-09-24
Onset:2012-09-24
Submitted:2012-10-01
Entered:2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58406 / - - / IM

Administered by: Other      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-28
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: unknown
Current Illness: None
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: unknown.
CDC 'Split Type':

Write-up: Pt daughter reported next day that explosive diarrhea occurred. Recommended ER or urgent care.


Changed on 4/14/2017

VAERS ID: 467090 Before After
VAERS Form:
Age:79.0
Sex:Male
Location:Missouri
Vaccinated:2012-09-24
Onset:2012-09-24
Submitted:2012-10-01
Entered:2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58406 / - - / IM

Administered by: Other      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-28
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: unknown
Current Illness: None
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: unknown.
CDC 'Split Type':

Write-up: Pt daughter reported next day that explosive diarrhea occurred. Recommended ER or urgent care.


Changed on 9/14/2017

VAERS ID: 467090 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Male
Location:Missouri
Vaccinated:2012-09-24
Onset:2012-09-24
Submitted:2012-10-01
Entered:2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58406 / - UNK - / IM

Administered by: Other      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-28
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: unknown
Current Illness: None
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: unknown.
CDC 'Split Type':

Write-up: Pt daughter reported next day that explosive diarrhea occurred. Recommended ER or urgent care.


Changed on 2/14/2018

VAERS ID: 467090 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Missouri
Vaccinated:2012-09-24
Onset:2012-09-24
Submitted:2012-10-01
Entered:2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58406 / UNK - / IM

Administered by: Other      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-28
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: unknown
Current Illness: None
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: unknown.
CDC 'Split Type':

Write-up: Pt daughter reported next day that explosive diarrhea occurred. Recommended ER or urgent care.


Changed on 6/14/2018

VAERS ID: 467090 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Missouri
Vaccinated:2012-09-24
Onset:2012-09-24
Submitted:2012-10-01
Entered:2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58406 / UNK - / IM

Administered by: Other      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-28
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: unknown
Current Illness: None
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: unknown.
CDC 'Split Type':

Write-up: Pt daughter reported next day that explosive diarrhea occurred. Recommended ER or urgent care.


Changed on 8/14/2018

VAERS ID: 467090 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Missouri
Vaccinated:2012-09-24
Onset:2012-09-24
Submitted:2012-10-01
Entered:2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58406 / UNK - / IM

Administered by: Other      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-28
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: unknown
Current Illness: None
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: unknown.
CDC 'Split Type':

Write-up: Pt daughter reported next day that explosive diarrhea occurred. Recommended ER or urgent care.


Changed on 9/14/2018

VAERS ID: 467090 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Missouri
Vaccinated:2012-09-24
Onset:2012-09-24
Submitted:2012-10-01
Entered:2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58406 / UNK - / IM

Administered by: Other      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-28
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: unknown
Current Illness: None
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: unknown.
CDC 'Split Type':

Write-up: Pt daughter reported next day that explosive diarrhea occurred. Recommended ER or urgent care.


Changed on 10/14/2018

VAERS ID: 467090 Before After
VAERS Form:1
Age:79.0
Sex:Male
Location:Missouri
Vaccinated:2012-09-24
Onset:2012-09-24
Submitted:2012-10-01
Entered:2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58406 / UNK - / IM

Administered by: Other      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-28
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: unknown
Current Illness: None
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: unknown.
CDC 'Split Type':

Write-up: Pt daughter reported next day that explosive diarrhea occurred. Recommended ER or urgent care.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=467090&WAYBACKHISTORY=ON


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