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This is VAERS ID 47309

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 47309
VAERS Form:
Age:65.3
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1992-1993 / WYETH 4928209 / - - / IM

Administered by: Military      Purchased by: Unknown
Symptoms: APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;


Changed on 12/8/2009

VAERS ID: 47309 Before After
VAERS Form:
Age:65.3
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-25 1992-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1992-1993 INFLUENZA (SEASONAL) (NO BRAND NAME, 92-93) / WYETH WYETH PHARMACEUTICALS, INC 4928209 / - - / IM

Administered by: Military      Purchased by: Unknown Military
Symptoms: Apnoea, Cardiac arrest, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;


Changed on 8/31/2010

VAERS ID: 47309 Before After
VAERS Form:
Age:65.3
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 92-93) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4928209 / - - / IM

Administered by: Military      Purchased by: Military
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;


Changed on 7/7/2013

VAERS ID: 47309 Before After
VAERS Form:
Age:65.3
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / - - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / - - / IM

Administered by: Military      Purchased by: Military
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;


Changed on 12/14/2016

VAERS ID: 47309 Before After
VAERS Form:
Age:65.3
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / - - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / - - / IM

Administered by: Military      Purchased by: Military
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;


Changed on 2/14/2017

VAERS ID: 47309 Before After
VAERS Form:
Age:65.3 65.0
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / - - / IM

Administered by: Military      Purchased by: Military
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;


Changed on 5/14/2017

VAERS ID: 47309 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / - - / IM

Administered by: Military      Purchased by: Military
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: ~ ()~~~In patient
Other Medications: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;


Changed on 9/14/2017

VAERS ID: 47309 Before After
VAERS Form:(blank) 1
Age:65.0
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / - UNK - / IM

Administered by: Military      Purchased by: Military
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: ~ ()~~~In patient
Other Medications: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;


Changed on 2/14/2018

VAERS ID: 47309 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / UNK - / IM

Administered by: Military      Purchased by: Military
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: ~ ()~~~In patient
Other Medications: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;


Changed on 6/14/2018

VAERS ID: 47309 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / UNK - / IM

Administered by: Military      Purchased by: Military
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: ~ ()~~~In patient
Other Medications: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;


Changed on 8/14/2018

VAERS ID: 47309 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / UNK - / IM

Administered by: Military      Purchased by: Military
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: ~ ()~~~In patient
Other Medications: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;


Changed on 9/14/2018

VAERS ID: 47309 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / UNK - / IM

Administered by: Military      Purchased by: Military
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: ~ ()~~~In patient
Other Medications: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;


Changed on 10/14/2018

VAERS ID: 47309 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:North Carolina
Vaccinated:1992-11-02
Onset:1992-11-02
Submitted:1992-11-04
Entered:1992-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928209 / UNK - / IM

Administered by: Military      Purchased by: Military
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-02
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: ~ ()~~~In patient
Other Medications: Colchicine HC cream, Indocin
Current Illness: COPD, WPW synd
Preexisting Conditions: procainamide, Sulfa
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: could not breath went into full arrest;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=47309&WAYBACKHISTORY=ON


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