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This is VAERS ID 467247

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2012

VAERS ID: 467247
VAERS Form:
Age:11.0
Sex:Male
Location:New York
Vaccinated:2012-09-26
Onset:2012-09-27
Submitted:2012-10-02
Entered:2012-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AA / 3 AR / IM

Administered by: Private      Purchased by: Public
Symptoms: Body temperature increased, Death, Moaning, Pain, Peripheral coldness, Resuscitation, Nasal flaring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-27
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: Multivitamin Levetiraceta Phenobarbitol Diazepam
Current Illness: None
Preexisting Conditions: MR/CP, seizure disorder, developmental delay
Allergies:
Diagnostic Lab Data: None. Family waived Medical Examiner review.
CDC 'Split Type':

Write-up: 11AM-O2 sats @74%, HR 204, temp 97.7, moaning, upper extremities cold. Tylenol given for pain. 1:10PM-nasal flaring, O2 sats @ 74%, HR 82, temp 99.9, RR 42. EMS called and subsequent code blue. Chest compressions and ambu-bagged, epinephrine given. Transferred to hospital. Pronounced dead at hospital.


Changed on 7/7/2013

VAERS ID: 467247 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:New York
Vaccinated:2012-09-26
Onset:2012-09-27
Submitted:2012-10-02
Entered:2012-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AA / 3 AR / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AA / 3 AR / IM

Administered by: Private      Purchased by: Public
Symptoms: Body temperature increased, Death, Moaning, Pain, Peripheral coldness, Resuscitation, Nasal flaring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-27
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: Multivitamin Levetiraceta Phenobarbitol Diazepam
Current Illness: None
Preexisting Conditions: MR/CP, seizure disorder, developmental delay
Allergies:
Diagnostic Lab Data: None. Family waived Medical Examiner review.
CDC 'Split Type':

Write-up: 11AM-O2 sats @74%, HR 204, temp 97.7, moaning, upper extremities cold. Tylenol given for pain. 1:10PM-nasal flaring, O2 sats @ 74%, HR 82, temp 99.9, RR 42. EMS called and subsequent code blue. Chest compressions and ambu-bagged, epinephrine given. Transferred to hospital. Pronounced dead at hospital.


Changed on 6/14/2014

VAERS ID: 467247 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:New York
Vaccinated:2012-09-26
Onset:2012-09-27
Submitted:2012-10-02
Entered:2012-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AA / 3 AR / IM

Administered by: Private      Purchased by: Public
Symptoms: Body temperature increased, Death, Moaning, Pain, Peripheral coldness, Resuscitation, Nasal flaring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-27
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: Multivitamin Levetiraceta Phenobarbitol Diazepam
Current Illness: None
Preexisting Conditions: MR/CP, seizure disorder, developmental delay
Allergies:
Diagnostic Lab Data: None. Family waived Medical Examiner review.
CDC 'Split Type':

Write-up: 11AM-O2 sats @74%, HR 204, temp 97.7, moaning, upper extremities cold. Tylenol given for pain. 1:10PM-nasal flaring, O2 sats @ 74%, HR 82, temp 99.9, RR 42. EMS called and subsequent code blue. Chest compressions and ambu-bagged, epinephrine given. Transferred to hospital. Pronounced dead at hospital.


Changed on 4/14/2017

VAERS ID: 467247 Before After
VAERS Form:
Age:11.0
Sex:Male
Location:New York
Vaccinated:2012-09-26
Onset:2012-09-27
Submitted:2012-10-02
Entered:2012-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AA / 3 AR / IM

Administered by: Private      Purchased by: Public
Symptoms: Body temperature increased, Death, Moaning, Pain, Peripheral coldness, Resuscitation, Nasal flaring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-27
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: Multivitamin Levetiraceta Phenobarbitol Diazepam
Current Illness: None
Preexisting Conditions: MR/CP, seizure disorder, developmental delay
Allergies:
Diagnostic Lab Data: None. Family waived Medical Examiner review.
CDC 'Split Type':

Write-up: 11AM-O2 sats @74%, HR 204, temp 97.7, moaning, upper extremities cold. Tylenol given for pain. 1:10PM-nasal flaring, O2 sats @ 74%, HR 82, temp 99.9, RR 42. EMS called and subsequent code blue. Chest compressions and ambu-bagged, epinephrine given. Transferred to hospital. Pronounced dead at hospital.


Changed on 9/14/2017

VAERS ID: 467247 Before After
VAERS Form:(blank) 1
Age:11.0
Sex:Male
Location:New York
Vaccinated:2012-09-26
Onset:2012-09-27
Submitted:2012-10-02
Entered:2012-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AA / 3 4 AR / IM

Administered by: Private      Purchased by: Public
Symptoms: Body temperature increased, Death, Moaning, Pain, Peripheral coldness, Resuscitation, Nasal flaring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-27
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: Multivitamin Levetiraceta Phenobarbitol Diazepam
Current Illness: None
Preexisting Conditions: MR/CP, seizure disorder, developmental delay
Allergies:
Diagnostic Lab Data: None. Family waived Medical Examiner review.
CDC 'Split Type':

Write-up: 11AM-O2 sats @74%, HR 204, temp 97.7, moaning, upper extremities cold. Tylenol given for pain. 1:10PM-nasal flaring, O2 sats @ 74%, HR 82, temp 99.9, RR 42. EMS called and subsequent code blue. Chest compressions and ambu-bagged, epinephrine given. Transferred to hospital. Pronounced dead at hospital.


Changed on 2/14/2018

VAERS ID: 467247 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:New York
Vaccinated:2012-09-26
Onset:2012-09-27
Submitted:2012-10-02
Entered:2012-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AA / 4 AR / IM

Administered by: Private      Purchased by: Public
Symptoms: Body temperature increased, Death, Moaning, Pain, Peripheral coldness, Resuscitation, Nasal flaring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-27
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: Multivitamin Levetiraceta Phenobarbitol Diazepam
Current Illness: None
Preexisting Conditions: MR/CP, seizure disorder, developmental delay
Allergies:
Diagnostic Lab Data: None. Family waived Medical Examiner review.
CDC 'Split Type':

Write-up: 11AM-O2 sats @74%, HR 204, temp 97.7, moaning, upper extremities cold. Tylenol given for pain. 1:10PM-nasal flaring, O2 sats @ 74%, HR 82, temp 99.9, RR 42. EMS called and subsequent code blue. Chest compressions and ambu-bagged, epinephrine given. Transferred to hospital. Pronounced dead at hospital.


Changed on 6/14/2018

VAERS ID: 467247 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:New York
Vaccinated:2012-09-26
Onset:2012-09-27
Submitted:2012-10-02
Entered:2012-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AA / 4 AR / IM

Administered by: Private      Purchased by: Public
Symptoms: Body temperature increased, Death, Moaning, Pain, Peripheral coldness, Resuscitation, Nasal flaring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-27
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: Multivitamin Levetiraceta Phenobarbitol Diazepam
Current Illness: None
Preexisting Conditions: MR/CP, seizure disorder, developmental delay
Allergies:
Diagnostic Lab Data: None. Family waived Medical Examiner review.
CDC 'Split Type':

Write-up: 11AM-O2 sats @74%, HR 204, temp 97.7, moaning, upper extremities cold. Tylenol given for pain. 1:10PM-nasal flaring, O2 sats @ 74%, HR 82, temp 99.9, RR 42. EMS called and subsequent code blue. Chest compressions and ambu-bagged, epinephrine given. Transferred to hospital. Pronounced dead at hospital.


Changed on 8/14/2018

VAERS ID: 467247 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:New York
Vaccinated:2012-09-26
Onset:2012-09-27
Submitted:2012-10-02
Entered:2012-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AA / 4 AR / IM

Administered by: Private      Purchased by: Public
Symptoms: Body temperature increased, Death, Moaning, Pain, Peripheral coldness, Resuscitation, Nasal flaring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-27
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: Multivitamin Levetiraceta Phenobarbitol Diazepam
Current Illness: None
Preexisting Conditions: MR/CP, seizure disorder, developmental delay
Allergies:
Diagnostic Lab Data: None. Family waived Medical Examiner review.
CDC 'Split Type':

Write-up: 11AM-O2 sats @74%, HR 204, temp 97.7, moaning, upper extremities cold. Tylenol given for pain. 1:10PM-nasal flaring, O2 sats @ 74%, HR 82, temp 99.9, RR 42. EMS called and subsequent code blue. Chest compressions and ambu-bagged, epinephrine given. Transferred to hospital. Pronounced dead at hospital.


Changed on 9/14/2018

VAERS ID: 467247 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:New York
Vaccinated:2012-09-26
Onset:2012-09-27
Submitted:2012-10-02
Entered:2012-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AA / 4 AR / IM

Administered by: Private      Purchased by: Public
Symptoms: Body temperature increased, Death, Moaning, Pain, Peripheral coldness, Resuscitation, Nasal flaring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-27
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: Multivitamin Levetiraceta Phenobarbitol Diazepam
Current Illness: None
Preexisting Conditions: MR/CP, seizure disorder, developmental delay
Allergies:
Diagnostic Lab Data: None. Family waived Medical Examiner review.
CDC 'Split Type':

Write-up: 11AM-O2 sats @74%, HR 204, temp 97.7, moaning, upper extremities cold. Tylenol given for pain. 1:10PM-nasal flaring, O2 sats @ 74%, HR 82, temp 99.9, RR 42. EMS called and subsequent code blue. Chest compressions and ambu-bagged, epinephrine given. Transferred to hospital. Pronounced dead at hospital.


Changed on 10/14/2018

VAERS ID: 467247 Before After
VAERS Form:1
Age:11.0
Sex:Male
Location:New York
Vaccinated:2012-09-26
Onset:2012-09-27
Submitted:2012-10-02
Entered:2012-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4482AA / 4 AR / IM

Administered by: Private      Purchased by: Public
Symptoms: Body temperature increased, Death, Moaning, Pain, Peripheral coldness, Resuscitation, Nasal flaring

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-27
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: Multivitamin Levetiraceta Phenobarbitol Diazepam
Current Illness: None
Preexisting Conditions: MR/CP, seizure disorder, developmental delay
Allergies:
Diagnostic Lab Data: None. Family waived Medical Examiner review.
CDC 'Split Type':

Write-up: 11AM-O2 sats @74%, HR 204, temp 97.7, moaning, upper extremities cold. Tylenol given for pain. 1:10PM-nasal flaring, O2 sats @ 74%, HR 82, temp 99.9, RR 42. EMS called and subsequent code blue. Chest compressions and ambu-bagged, epinephrine given. Transferred to hospital. Pronounced dead at hospital.

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