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This is VAERS ID 467340

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2012

VAERS ID: 467340
VAERS Form:
Age:49.0
Sex:Male
Location:Unknown
Vaccinated:2012-09-25
Onset:2012-09-26
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204901 / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Malaise, Myocardial infarction, Nausea

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US019182

Write-up: Case number PHEH2012US019182 is an initial spontaneous report received from a pharmacist on 28 Sep 2012. This report refers to a 49-years-old male patient whose medical history and concomitant medications were not reported. He was vaccinated with FLUVIRIN (batch number: 1204901, expiry date: May 2013) intramuscularly on 25 Sep 2012. On 26 Sep 2012, he felt sick and nauseous. It was reported that he suffered a heart attack at his work site and expired before the ambulance arrived on 27 Sep 2012. No further information was available.


Changed on 7/7/2013

VAERS ID: 467340 Before After
VAERS Form:
Age:49.0
Sex:Male
Location:Unknown
Vaccinated:2012-09-25
Onset:2012-09-26
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204901 / - UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204901 / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Malaise, Myocardial infarction, Nausea

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US019182

Write-up: Case number PHEH2012US019182 is an initial spontaneous report received from a pharmacist on 28 Sep 2012. This report refers to a 49-years-old male patient whose medical history and concomitant medications were not reported. He was vaccinated with FLUVIRIN (batch number: 1204901, expiry date: May 2013) intramuscularly on 25 Sep 2012. On 26 Sep 2012, he felt sick and nauseous. It was reported that he suffered a heart attack at his work site and expired before the ambulance arrived on 27 Sep 2012. No further information was available.


Changed on 6/14/2014

VAERS ID: 467340 Before After
VAERS Form:
Age:49.0
Sex:Male
Location:Unknown
Vaccinated:2012-09-25
Onset:2012-09-26
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204901 / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Malaise, Myocardial infarction, Nausea

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US019182

Write-up: Case number PHEH2012US019182 is an initial spontaneous report received from a pharmacist on 28 Sep 2012. This report refers to a 49-years-old male patient whose medical history and concomitant medications were not reported. He was vaccinated with FLUVIRIN (batch number: 1204901, expiry date: May 2013) intramuscularly on 25 Sep 2012. On 26 Sep 2012, he felt sick and nauseous. It was reported that he suffered a heart attack at his work site and expired before the ambulance arrived on 27 Sep 2012. No further information was available.


Changed on 4/14/2017

VAERS ID: 467340 Before After
VAERS Form:
Age:49.0
Sex:Male
Location:Unknown
Vaccinated:2012-09-25
Onset:2012-09-26
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204901 / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Malaise, Myocardial infarction, Nausea

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US019182

Write-up: Case number PHEH2012US019182 is an initial spontaneous report received from a pharmacist on 28 Sep 2012. This report refers to a 49-years-old male patient whose medical history and concomitant medications were not reported. He was vaccinated with FLUVIRIN (batch number: 1204901, expiry date: May 2013) intramuscularly on 25 Sep 2012. On 26 Sep 2012, he felt sick and nauseous. It was reported that he suffered a heart attack at his work site and expired before the ambulance arrived on 27 Sep 2012. No further information was available.


Changed on 9/14/2017

VAERS ID: 467340 Before After
VAERS Form:(blank) 1
Age:49.0
Sex:Male
Location:Unknown
Vaccinated:2012-09-25
Onset:2012-09-26
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204901 / - UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Malaise, Myocardial infarction, Nausea

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US019182

Write-up: Case number PHEH2012US019182 is an initial spontaneous report received from a pharmacist on 28 Sep 2012. This report refers to a 49-years-old male patient whose medical history and concomitant medications were not reported. He was vaccinated with FLUVIRIN (batch number: 1204901, expiry date: May 2013) intramuscularly on 25 Sep 2012. On 26 Sep 2012, he felt sick and nauseous. It was reported that he suffered a heart attack at his work site and expired before the ambulance arrived on 27 Sep 2012. No further information was available.


Changed on 2/14/2018

VAERS ID: 467340 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Unknown
Vaccinated:2012-09-25
Onset:2012-09-26
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204901 / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Malaise, Myocardial infarction, Nausea

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US019182

Write-up: Case number PHEH2012US019182 is an initial spontaneous report received from a pharmacist on 28 Sep 2012. This report refers to a 49-years-old male patient whose medical history and concomitant medications were not reported. He was vaccinated with FLUVIRIN (batch number: 1204901, expiry date: May 2013) intramuscularly on 25 Sep 2012. On 26 Sep 2012, he felt sick and nauseous. It was reported that he suffered a heart attack at his work site and expired before the ambulance arrived on 27 Sep 2012. No further information was available.


Changed on 6/14/2018

VAERS ID: 467340 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Unknown
Vaccinated:2012-09-25
Onset:2012-09-26
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204901 / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Malaise, Myocardial infarction, Nausea

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US019182

Write-up: Case number PHEH2012US019182 is an initial spontaneous report received from a pharmacist on 28 Sep 2012. This report refers to a 49-years-old male patient whose medical history and concomitant medications were not reported. He was vaccinated with FLUVIRIN (batch number: 1204901, expiry date: May 2013) intramuscularly on 25 Sep 2012. On 26 Sep 2012, he felt sick and nauseous. It was reported that he suffered a heart attack at his work site and expired before the ambulance arrived on 27 Sep 2012. No further information was available.


Changed on 8/14/2018

VAERS ID: 467340 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Unknown
Vaccinated:2012-09-25
Onset:2012-09-26
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204901 / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Malaise, Myocardial infarction, Nausea

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US019182

Write-up: Case number PHEH2012US019182 is an initial spontaneous report received from a pharmacist on 28 Sep 2012. This report refers to a 49-years-old male patient whose medical history and concomitant medications were not reported. He was vaccinated with FLUVIRIN (batch number: 1204901, expiry date: May 2013) intramuscularly on 25 Sep 2012. On 26 Sep 2012, he felt sick and nauseous. It was reported that he suffered a heart attack at his work site and expired before the ambulance arrived on 27 Sep 2012. No further information was available.


Changed on 9/14/2018

VAERS ID: 467340 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Unknown
Vaccinated:2012-09-25
Onset:2012-09-26
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204901 / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Malaise, Myocardial infarction, Nausea

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US019182

Write-up: Case number PHEH2012US019182 is an initial spontaneous report received from a pharmacist on 28 Sep 2012. This report refers to a 49-years-old male patient whose medical history and concomitant medications were not reported. He was vaccinated with FLUVIRIN (batch number: 1204901, expiry date: May 2013) intramuscularly on 25 Sep 2012. On 26 Sep 2012, he felt sick and nauseous. It was reported that he suffered a heart attack at his work site and expired before the ambulance arrived on 27 Sep 2012. No further information was available.


Changed on 10/14/2018

VAERS ID: 467340 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Unknown
Vaccinated:2012-09-25
Onset:2012-09-26
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204901 / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Malaise, Myocardial infarction, Nausea

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US019182

Write-up: Case number PHEH2012US019182 is an initial spontaneous report received from a pharmacist on 28 Sep 2012. This report refers to a 49-years-old male patient whose medical history and concomitant medications were not reported. He was vaccinated with FLUVIRIN (batch number: 1204901, expiry date: May 2013) intramuscularly on 25 Sep 2012. On 26 Sep 2012, he felt sick and nauseous. It was reported that he suffered a heart attack at his work site and expired before the ambulance arrived on 27 Sep 2012. No further information was available.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=467340&WAYBACKHISTORY=ON


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