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This is VAERS ID 468865

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2012

VAERS ID: 468865
VAERS Form:
Age:86.0
Sex:Male
Location:Ohio
Vaccinated:2012-10-03
Onset:2012-10-04
Submitted:2012-10-10
Entered:2012-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204201 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-04
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: vitamin D, mirtazapine, omeprazole, hydrochlorothiazide, loratadine, tramadol, docusate
Current Illness: no infectious illnesses at time of vaccination
Preexisting Conditions: NKDA Adult Failure to Thrive Esophageal stricture, HTN, Osteoarthritis, Dementia
Allergies:
Diagnostic Lab Data: Pt had chronic illnesses including being very malnourished, weighing 102# and being 6''2".
CDC 'Split Type':

Write-up: Per family pt had a good day and eve, no signs of allergic reaction or difficulty. He failed to wake up the next morning. Time of death 10:37 AM.


Changed on 7/7/2013

VAERS ID: 468865 Before After
VAERS Form:
Age:86.0
Sex:Male
Location:Ohio
Vaccinated:2012-10-03
Onset:2012-10-04
Submitted:2012-10-10
Entered:2012-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204201 / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204201 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-04
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: vitamin D, mirtazapine, omeprazole, hydrochlorothiazide, loratadine, tramadol, docusate
Current Illness: no infectious illnesses at time of vaccination
Preexisting Conditions: NKDA Adult Failure to Thrive Esophageal stricture, HTN, Osteoarthritis, Dementia
Allergies:
Diagnostic Lab Data: Pt had chronic illnesses including being very malnourished, weighing 102# and being 6''2".
CDC 'Split Type':

Write-up: Per family pt had a good day and eve, no signs of allergic reaction or difficulty. He failed to wake up the next morning. Time of death 10:37 AM.


Changed on 6/14/2014

VAERS ID: 468865 Before After
VAERS Form:
Age:86.0
Sex:Male
Location:Ohio
Vaccinated:2012-10-03
Onset:2012-10-04
Submitted:2012-10-10
Entered:2012-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204201 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-04
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: vitamin D, mirtazapine, omeprazole, hydrochlorothiazide, loratadine, tramadol, docusate
Current Illness: no infectious illnesses at time of vaccination
Preexisting Conditions: NKDA Adult Failure to Thrive Esophageal stricture, HTN, Osteoarthritis, Dementia
Allergies:
Diagnostic Lab Data: Pt had chronic illnesses including being very malnourished, weighing 102# and being 6''2".
CDC 'Split Type':

Write-up: Per family pt had a good day and eve, no signs of allergic reaction or difficulty. He failed to wake up the next morning. Time of death 10:37 AM.


Changed on 4/14/2017

VAERS ID: 468865 Before After
VAERS Form:
Age:86.0
Sex:Male
Location:Ohio
Vaccinated:2012-10-03
Onset:2012-10-04
Submitted:2012-10-10
Entered:2012-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204201 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-04
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: vitamin D, mirtazapine, omeprazole, hydrochlorothiazide, loratadine, tramadol, docusate
Current Illness: no infectious illnesses at time of vaccination
Preexisting Conditions: NKDA Adult Failure to Thrive Esophageal stricture, HTN, Osteoarthritis, Dementia
Allergies:
Diagnostic Lab Data: Pt had chronic illnesses including being very malnourished, weighing 102# and being 6''2".
CDC 'Split Type':

Write-up: Per family pt had a good day and eve, no signs of allergic reaction or difficulty. He failed to wake up the next morning. Time of death 10:37 AM.


Changed on 9/14/2017

VAERS ID: 468865 Before After
VAERS Form:(blank) 1
Age:86.0
Sex:Male
Location:Ohio
Vaccinated:2012-10-03
Onset:2012-10-04
Submitted:2012-10-10
Entered:2012-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204201 / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-04
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: vitamin D, mirtazapine, omeprazole, hydrochlorothiazide, loratadine, tramadol, docusate
Current Illness: no infectious illnesses at time of vaccination
Preexisting Conditions: NKDA Adult Failure to Thrive Esophageal stricture, HTN, Osteoarthritis, Dementia
Allergies:
Diagnostic Lab Data: Pt had chronic illnesses including being very malnourished, weighing 102# and being 6''2".
CDC 'Split Type':

Write-up: Per family pt had a good day and eve, no signs of allergic reaction or difficulty. He failed to wake up the next morning. Time of death 10:37 AM.


Changed on 2/14/2018

VAERS ID: 468865 Before After
VAERS Form:1
Age:86.0
Sex:Male
Location:Ohio
Vaccinated:2012-10-03
Onset:2012-10-04
Submitted:2012-10-10
Entered:2012-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204201 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-04
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: vitamin D, mirtazapine, omeprazole, hydrochlorothiazide, loratadine, tramadol, docusate
Current Illness: no infectious illnesses at time of vaccination
Preexisting Conditions: NKDA Adult Failure to Thrive Esophageal stricture, HTN, Osteoarthritis, Dementia
Allergies:
Diagnostic Lab Data: Pt had chronic illnesses including being very malnourished, weighing 102# and being 6''2".
CDC 'Split Type':

Write-up: Per family pt had a good day and eve, no signs of allergic reaction or difficulty. He failed to wake up the next morning. Time of death 10:37 AM.


Changed on 6/14/2018

VAERS ID: 468865 Before After
VAERS Form:1
Age:86.0
Sex:Male
Location:Ohio
Vaccinated:2012-10-03
Onset:2012-10-04
Submitted:2012-10-10
Entered:2012-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204201 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-04
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: vitamin D, mirtazapine, omeprazole, hydrochlorothiazide, loratadine, tramadol, docusate
Current Illness: no infectious illnesses at time of vaccination
Preexisting Conditions: NKDA Adult Failure to Thrive Esophageal stricture, HTN, Osteoarthritis, Dementia
Allergies:
Diagnostic Lab Data: Pt had chronic illnesses including being very malnourished, weighing 102# and being 6''2".
CDC 'Split Type':

Write-up: Per family pt had a good day and eve, no signs of allergic reaction or difficulty. He failed to wake up the next morning. Time of death 10:37 AM.


Changed on 8/14/2018

VAERS ID: 468865 Before After
VAERS Form:1
Age:86.0
Sex:Male
Location:Ohio
Vaccinated:2012-10-03
Onset:2012-10-04
Submitted:2012-10-10
Entered:2012-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204201 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-04
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: vitamin D, mirtazapine, omeprazole, hydrochlorothiazide, loratadine, tramadol, docusate
Current Illness: no infectious illnesses at time of vaccination
Preexisting Conditions: NKDA Adult Failure to Thrive Esophageal stricture, HTN, Osteoarthritis, Dementia
Allergies:
Diagnostic Lab Data: Pt had chronic illnesses including being very malnourished, weighing 102# and being 6''2".
CDC 'Split Type':

Write-up: Per family pt had a good day and eve, no signs of allergic reaction or difficulty. He failed to wake up the next morning. Time of death 10:37 AM.


Changed on 9/14/2018

VAERS ID: 468865 Before After
VAERS Form:1
Age:86.0
Sex:Male
Location:Ohio
Vaccinated:2012-10-03
Onset:2012-10-04
Submitted:2012-10-10
Entered:2012-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204201 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-04
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: vitamin D, mirtazapine, omeprazole, hydrochlorothiazide, loratadine, tramadol, docusate
Current Illness: no infectious illnesses at time of vaccination
Preexisting Conditions: NKDA Adult Failure to Thrive Esophageal stricture, HTN, Osteoarthritis, Dementia
Allergies:
Diagnostic Lab Data: Pt had chronic illnesses including being very malnourished, weighing 102# and being 6''2".
CDC 'Split Type':

Write-up: Per family pt had a good day and eve, no signs of allergic reaction or difficulty. He failed to wake up the next morning. Time of death 10:37 AM.


Changed on 10/14/2018

VAERS ID: 468865 Before After
VAERS Form:1
Age:86.0
Sex:Male
Location:Ohio
Vaccinated:2012-10-03
Onset:2012-10-04
Submitted:2012-10-10
Entered:2012-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204201 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-04
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: vitamin D, mirtazapine, omeprazole, hydrochlorothiazide, loratadine, tramadol, docusate
Current Illness: no infectious illnesses at time of vaccination
Preexisting Conditions: NKDA Adult Failure to Thrive Esophageal stricture, HTN, Osteoarthritis, Dementia
Allergies:
Diagnostic Lab Data: Pt had chronic illnesses including being very malnourished, weighing 102# and being 6''2".
CDC 'Split Type':

Write-up: Per family pt had a good day and eve, no signs of allergic reaction or difficulty. He failed to wake up the next morning. Time of death 10:37 AM.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=468865&WAYBACKHISTORY=ON


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