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This is VAERS ID 469713

History of Changes from the VAERS Wayback Machine

First Appeared on 11/13/2012

VAERS ID: 469713
VAERS Form:
Age:77.0
Sex:Male
Location:Washington
Vaccinated:2012-09-18
Onset:2012-09-18
Submitted:2012-10-11
Entered:2012-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 12251P / 1 RA / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Respiratory depression, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-18
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: Recently discharged for CHF exacerbation
Preexisting Conditions: CHF; Peripheral vascular disease; Hyperlipidemia; Atrial fibrillation; Foot amputation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resp. Depression, Tachycardia and Cardiac Arrest. Epinephrine 1 MG Other, Dopamine 10 MCG Other.


Changed on 7/7/2013

VAERS ID: 469713 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Washington
Vaccinated:2012-09-18
Onset:2012-09-18
Submitted:2012-10-11
Entered:2012-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 12251P / 1 RA / UN
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 12251P / 1 RA / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Respiratory depression, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-18
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: Recently discharged for CHF exacerbation
Preexisting Conditions: CHF; Peripheral vascular disease; Hyperlipidemia; Atrial fibrillation; Foot amputation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resp. Depression, Tachycardia and Cardiac Arrest. Epinephrine 1 MG Other, Dopamine 10 MCG Other.


Changed on 9/14/2017

VAERS ID: 469713 Before After
VAERS Form:(blank) 1
Age:77.0
Sex:Male
Location:Washington
Vaccinated:2012-09-18
Onset:2012-09-18
Submitted:2012-10-11
Entered:2012-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 12251P / 1 2 RA / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Respiratory depression, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-18
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: Recently discharged for CHF exacerbation
Preexisting Conditions: CHF; Peripheral vascular disease; Hyperlipidemia; Atrial fibrillation; Foot amputation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resp. Depression, Tachycardia and Cardiac Arrest. Epinephrine 1 MG Other, Dopamine 10 MCG Other.


Changed on 2/14/2018

VAERS ID: 469713 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Washington
Vaccinated:2012-09-18
Onset:2012-09-18
Submitted:2012-10-11
Entered:2012-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 12251P / 2 RA / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Respiratory depression, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-18
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: Recently discharged for CHF exacerbation
Preexisting Conditions: CHF; Peripheral vascular disease; Hyperlipidemia; Atrial fibrillation; Foot amputation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resp. Depression, Tachycardia and Cardiac Arrest. Epinephrine 1 MG Other, Dopamine 10 MCG Other.


Changed on 6/14/2018

VAERS ID: 469713 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Washington
Vaccinated:2012-09-18
Onset:2012-09-18
Submitted:2012-10-11
Entered:2012-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 12251P / 2 RA / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Respiratory depression, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-18
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: Recently discharged for CHF exacerbation
Preexisting Conditions: CHF; Peripheral vascular disease; Hyperlipidemia; Atrial fibrillation; Foot amputation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resp. Depression, Tachycardia and Cardiac Arrest. Epinephrine 1 MG Other, Dopamine 10 MCG Other.


Changed on 8/14/2018

VAERS ID: 469713 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Washington
Vaccinated:2012-09-18
Onset:2012-09-18
Submitted:2012-10-11
Entered:2012-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 12251P / 2 RA / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Respiratory depression, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-18
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: Recently discharged for CHF exacerbation
Preexisting Conditions: CHF; Peripheral vascular disease; Hyperlipidemia; Atrial fibrillation; Foot amputation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resp. Depression, Tachycardia and Cardiac Arrest. Epinephrine 1 MG Other, Dopamine 10 MCG Other.


Changed on 9/14/2018

VAERS ID: 469713 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Washington
Vaccinated:2012-09-18
Onset:2012-09-18
Submitted:2012-10-11
Entered:2012-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 12251P / 2 RA / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Respiratory depression, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-18
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: Recently discharged for CHF exacerbation
Preexisting Conditions: CHF; Peripheral vascular disease; Hyperlipidemia; Atrial fibrillation; Foot amputation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resp. Depression, Tachycardia and Cardiac Arrest. Epinephrine 1 MG Other, Dopamine 10 MCG Other.


Changed on 10/14/2018

VAERS ID: 469713 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Washington
Vaccinated:2012-09-18
Onset:2012-09-18
Submitted:2012-10-11
Entered:2012-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 12251P / 2 RA / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Respiratory depression, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-18
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: Recently discharged for CHF exacerbation
Preexisting Conditions: CHF; Peripheral vascular disease; Hyperlipidemia; Atrial fibrillation; Foot amputation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resp. Depression, Tachycardia and Cardiac Arrest. Epinephrine 1 MG Other, Dopamine 10 MCG Other.

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