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This is VAERS ID 475174

History of Changes from the VAERS Wayback Machine

First Appeared on 12/11/2012

VAERS ID: 475174
VAERS Form:
Age:88.0
Sex:Female
Location:Unknown
Vaccinated:2012-09-22
Onset:2012-10-08
Submitted:2012-11-21
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4466BA / - UN / ID

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-08
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:
Preexisting Conditions: The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen.
Allergies:
Diagnostic Lab Data: Not reported.
CDC 'Split Type': 201210777

Write-up: Initial report was received from a consumer on 14 November 2012, and involves a case of misuse, inappropriate age at vaccine administration. An 88-year-old female patient received an injection of FLUZONE Intradermal, sanofi pasteur Inc., (lot number, route, site, side and dose in series not reported) on 22 September 2012, which is indicated for patients 18 to 64 years of age. On 08 October 2012, 16 days post vaccination, the patient was found dead. The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen. It was not reported if an autopsy was done. No other details were provided. The patient''s outcome was reported as fatal on 08 October 2012. Documents held by sender: None.


Changed on 7/7/2013

VAERS ID: 475174 Before After
VAERS Form:
Age:88.0
Sex:Female
Location:Unknown
Vaccinated:2012-09-22
Onset:2012-10-08
Submitted:2012-11-21
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4466BA / - UN / ID
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4466BA / - UN / ID

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-08
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:
Preexisting Conditions: The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen.
Allergies:
Diagnostic Lab Data: Not reported.
CDC 'Split Type': 201210777

Write-up: Initial report was received from a consumer on 14 November 2012, and involves a case of misuse, inappropriate age at vaccine administration. An 88-year-old female patient received an injection of FLUZONE Intradermal, sanofi pasteur Inc., (lot number, route, site, side and dose in series not reported) on 22 September 2012, which is indicated for patients 18 to 64 years of age. On 08 October 2012, 16 days post vaccination, the patient was found dead. The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen. It was not reported if an autopsy was done. No other details were provided. The patient''s outcome was reported as fatal on 08 October 2012. Documents held by sender: None.


Changed on 9/14/2017

VAERS ID: 475174 Before After
VAERS Form:(blank) 1
Age:88.0
Sex:Female
Location:Unknown
Vaccinated:2012-09-22
Onset:2012-10-08
Submitted:2012-11-21
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4466BA / - UNK UN / ID

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-08
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:
Preexisting Conditions: The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen.
Allergies:
Diagnostic Lab Data: Not reported.
CDC 'Split Type': 201210777

Write-up: Initial report was received from a consumer on 14 November 2012, and involves a case of misuse, inappropriate age at vaccine administration. An 88-year-old female patient received an injection of FLUZONE Intradermal, sanofi pasteur Inc., (lot number, route, site, side and dose in series not reported) on 22 September 2012, which is indicated for patients 18 to 64 years of age. On 08 October 2012, 16 days post vaccination, the patient was found dead. The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen. It was not reported if an autopsy was done. No other details were provided. The patient''s outcome was reported as fatal on 08 October 2012. Documents held by sender: None.


Changed on 2/14/2018

VAERS ID: 475174 Before After
VAERS Form:1
Age:88.0
Sex:Female
Location:Unknown
Vaccinated:2012-09-22
Onset:2012-10-08
Submitted:2012-11-21
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4466BA / UNK UN / ID

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-08
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:
Preexisting Conditions: The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen.
Allergies:
Diagnostic Lab Data: Not reported.
CDC 'Split Type': 201210777

Write-up: Initial report was received from a consumer on 14 November 2012, and involves a case of misuse, inappropriate age at vaccine administration. An 88-year-old female patient received an injection of FLUZONE Intradermal, sanofi pasteur Inc., (lot number, route, site, side and dose in series not reported) on 22 September 2012, which is indicated for patients 18 to 64 years of age. On 08 October 2012, 16 days post vaccination, the patient was found dead. The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen. It was not reported if an autopsy was done. No other details were provided. The patient''s outcome was reported as fatal on 08 October 2012. Documents held by sender: None.


Changed on 6/14/2018

VAERS ID: 475174 Before After
VAERS Form:1
Age:88.0
Sex:Female
Location:Unknown
Vaccinated:2012-09-22
Onset:2012-10-08
Submitted:2012-11-21
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4466BA / UNK UN / ID

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-08
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:
Preexisting Conditions: The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen.
Allergies:
Diagnostic Lab Data: Not reported.
CDC 'Split Type': 201210777

Write-up: Initial report was received from a consumer on 14 November 2012, and involves a case of misuse, inappropriate age at vaccine administration. An 88-year-old female patient received an injection of FLUZONE Intradermal, sanofi pasteur Inc., (lot number, route, site, side and dose in series not reported) on 22 September 2012, which is indicated for patients 18 to 64 years of age. On 08 October 2012, 16 days post vaccination, the patient was found dead. The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen. It was not reported if an autopsy was done. No other details were provided. The patient''s outcome was reported as fatal on 08 October 2012. Documents held by sender: None.


Changed on 8/14/2018

VAERS ID: 475174 Before After
VAERS Form:1
Age:88.0
Sex:Female
Location:Unknown
Vaccinated:2012-09-22
Onset:2012-10-08
Submitted:2012-11-21
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4466BA / UNK UN / ID

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-08
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:
Preexisting Conditions: The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen.
Allergies:
Diagnostic Lab Data: Not reported.
CDC 'Split Type': 201210777

Write-up: Initial report was received from a consumer on 14 November 2012, and involves a case of misuse, inappropriate age at vaccine administration. An 88-year-old female patient received an injection of FLUZONE Intradermal, sanofi pasteur Inc., (lot number, route, site, side and dose in series not reported) on 22 September 2012, which is indicated for patients 18 to 64 years of age. On 08 October 2012, 16 days post vaccination, the patient was found dead. The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen. It was not reported if an autopsy was done. No other details were provided. The patient''s outcome was reported as fatal on 08 October 2012. Documents held by sender: None.


Changed on 9/14/2018

VAERS ID: 475174 Before After
VAERS Form:1
Age:88.0
Sex:Female
Location:Unknown
Vaccinated:2012-09-22
Onset:2012-10-08
Submitted:2012-11-21
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4466BA / UNK UN / ID

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-08
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:
Preexisting Conditions: The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen.
Allergies:
Diagnostic Lab Data: Not reported.
CDC 'Split Type': 201210777

Write-up: Initial report was received from a consumer on 14 November 2012, and involves a case of misuse, inappropriate age at vaccine administration. An 88-year-old female patient received an injection of FLUZONE Intradermal, sanofi pasteur Inc., (lot number, route, site, side and dose in series not reported) on 22 September 2012, which is indicated for patients 18 to 64 years of age. On 08 October 2012, 16 days post vaccination, the patient was found dead. The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen. It was not reported if an autopsy was done. No other details were provided. The patient''s outcome was reported as fatal on 08 October 2012. Documents held by sender: None.


Changed on 10/14/2018

VAERS ID: 475174 Before After
VAERS Form:1
Age:88.0
Sex:Female
Location:Unknown
Vaccinated:2012-09-22
Onset:2012-10-08
Submitted:2012-11-21
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4466BA / UNK UN / ID

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Drug administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-08
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:
Preexisting Conditions: The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen.
Allergies:
Diagnostic Lab Data: Not reported.
CDC 'Split Type': 201210777

Write-up: Initial report was received from a consumer on 14 November 2012, and involves a case of misuse, inappropriate age at vaccine administration. An 88-year-old female patient received an injection of FLUZONE Intradermal, sanofi pasteur Inc., (lot number, route, site, side and dose in series not reported) on 22 September 2012, which is indicated for patients 18 to 64 years of age. On 08 October 2012, 16 days post vaccination, the patient was found dead. The patient''s past medical history was reported as not applicable (n/a) and illness at time of vaccination was reported as none. The patient used home oxygen. It was not reported if an autopsy was done. No other details were provided. The patient''s outcome was reported as fatal on 08 October 2012. Documents held by sender: None.

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