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This is VAERS ID 467381

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2012

VAERS ID: 467381
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US018706

Write-up: Case number PHEH2012US018706, is an initial spontaneous report received from a consumer on 21 Sep 2012 with a follow up information received on 24 Sep 2012: This report refers to a female patient whose age was not reported. She was vaccinated with influenza vaccine (unknown manufacturer and batch number) on an unknown date. On an unspecified date she died following a flu shot. Cause of death was not reported. Causality assessment was not reported. No further information was provided. Follow up information received on 24 Sep 2012: Gender of the patient was updated.


Changed on 7/7/2013

VAERS ID: 467381 Before After
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US018706

Write-up: Case number PHEH2012US018706, is an initial spontaneous report received from a consumer on 21 Sep 2012 with a follow up information received on 24 Sep 2012: This report refers to a female patient whose age was not reported. She was vaccinated with influenza vaccine (unknown manufacturer and batch number) on an unknown date. On an unspecified date she died following a flu shot. Cause of death was not reported. Causality assessment was not reported. No further information was provided. Follow up information received on 24 Sep 2012: Gender of the patient was updated.


Changed on 6/14/2014

VAERS ID: 467381 Before After
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US018706

Write-up: Case number PHEH2012US018706, is an initial spontaneous report received from a consumer on 21 Sep 2012 with a follow up information received on 24 Sep 2012: This report refers to a female patient whose age was not reported. She was vaccinated with influenza vaccine (unknown manufacturer and batch number) on an unknown date. On an unspecified date she died following a flu shot. Cause of death was not reported. Causality assessment was not reported. No further information was provided. Follow up information received on 24 Sep 2012: Gender of the patient was updated.


Changed on 12/14/2016

VAERS ID: 467381 Before After
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

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:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US018706

Write-up: Case number PHEH2012US018706, is an initial spontaneous report received from a consumer on 21 Sep 2012 with a follow up information received on 24 Sep 2012: This report refers to a female patient whose age was not reported. She was vaccinated with influenza vaccine (unknown manufacturer and batch number) on an unknown date. On an unspecified date she died following a flu shot. Cause of death was not reported. Causality assessment was not reported. No further information was provided. Follow up information received on 24 Sep 2012: Gender of the patient was updated.


Changed on 4/14/2017

VAERS ID: 467381 Before After
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US018706

Write-up: Case number PHEH2012US018706, is an initial spontaneous report received from a consumer on 21 Sep 2012 with a follow up information received on 24 Sep 2012: This report refers to a female patient whose age was not reported. She was vaccinated with influenza vaccine (unknown manufacturer and batch number) on an unknown date. On an unspecified date she died following a flu shot. Cause of death was not reported. Causality assessment was not reported. No further information was provided. Follow up information received on 24 Sep 2012: Gender of the patient was updated.


Changed on 9/14/2017

VAERS ID: 467381 Before After
VAERS Form:(blank) 1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US018706

Write-up: Case number PHEH2012US018706, is an initial spontaneous report received from a consumer on 21 Sep 2012 with a follow up information received on 24 Sep 2012: This report refers to a female patient whose age was not reported. She was vaccinated with influenza vaccine (unknown manufacturer and batch number) on an unknown date. On an unspecified date she died following a flu shot. Cause of death was not reported. Causality assessment was not reported. No further information was provided. Follow up information received on 24 Sep 2012: Gender of the patient was updated.


Changed on 2/14/2018

VAERS ID: 467381 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US018706

Write-up: Case number PHEH2012US018706, is an initial spontaneous report received from a consumer on 21 Sep 2012 with a follow up information received on 24 Sep 2012: This report refers to a female patient whose age was not reported. She was vaccinated with influenza vaccine (unknown manufacturer and batch number) on an unknown date. On an unspecified date she died following a flu shot. Cause of death was not reported. Causality assessment was not reported. No further information was provided. Follow up information received on 24 Sep 2012: Gender of the patient was updated.


Changed on 6/14/2018

VAERS ID: 467381 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US018706

Write-up: Case number PHEH2012US018706, is an initial spontaneous report received from a consumer on 21 Sep 2012 with a follow up information received on 24 Sep 2012: This report refers to a female patient whose age was not reported. She was vaccinated with influenza vaccine (unknown manufacturer and batch number) on an unknown date. On an unspecified date she died following a flu shot. Cause of death was not reported. Causality assessment was not reported. No further information was provided. Follow up information received on 24 Sep 2012: Gender of the patient was updated.


Changed on 8/14/2018

VAERS ID: 467381 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US018706

Write-up: Case number PHEH2012US018706, is an initial spontaneous report received from a consumer on 21 Sep 2012 with a follow up information received on 24 Sep 2012: This report refers to a female patient whose age was not reported. She was vaccinated with influenza vaccine (unknown manufacturer and batch number) on an unknown date. On an unspecified date she died following a flu shot. Cause of death was not reported. Causality assessment was not reported. No further information was provided. Follow up information received on 24 Sep 2012: Gender of the patient was updated.


Changed on 9/14/2018

VAERS ID: 467381 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US018706

Write-up: Case number PHEH2012US018706, is an initial spontaneous report received from a consumer on 21 Sep 2012 with a follow up information received on 24 Sep 2012: This report refers to a female patient whose age was not reported. She was vaccinated with influenza vaccine (unknown manufacturer and batch number) on an unknown date. On an unspecified date she died following a flu shot. Cause of death was not reported. Causality assessment was not reported. No further information was provided. Follow up information received on 24 Sep 2012: Gender of the patient was updated.


Changed on 10/14/2018

VAERS ID: 467381 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2012-10-03
Entered:2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Death

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PHEH2012US018706

Write-up: Case number PHEH2012US018706, is an initial spontaneous report received from a consumer on 21 Sep 2012 with a follow up information received on 24 Sep 2012: This report refers to a female patient whose age was not reported. She was vaccinated with influenza vaccine (unknown manufacturer and batch number) on an unknown date. On an unspecified date she died following a flu shot. Cause of death was not reported. Causality assessment was not reported. No further information was provided. Follow up information received on 24 Sep 2012: Gender of the patient was updated.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=467381&WAYBACKHISTORY=ON


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