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This is VAERS ID 476377

History of Changes from the VAERS Wayback Machine

First Appeared on 12/11/2012

VAERS ID: 476377
VAERS Form:
Age:89.0
Sex:Female
Location:New York
Vaccinated:2012-10-02
Onset:2012-10-14
Submitted:2012-12-04
Entered:2012-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4489AA / - LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Anaemia, Blood culture, Candidiasis, Chest X-ray, Computerised tomogram, Culture urine, Death, Echocardiogram, Fatigue, Full blood count, Hyperhidrosis, Malaise, Pyrexia, Ultrasound scan, Urine analysis, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-30
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg, Metoprolol ER 25mg, Isosorbide mononitrate 60mg, Fluoxetine 20mg, Hydrocodone/APAP 7.5/500, Omeprazole 20mg, ASA 81mg, Lidoderm patch 5%, Pravastatin 40mg.
Current Illness: None specifically known.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data: Blood cultures, blood analysis (CBC, etc), urine cultures and analysis, CT scans, chest x-rays, sonogram, echo-cardiogram, and possibly more tests were given.
CDC 'Split Type':

Write-up: Fevers (102.6 max), sweating, fatigue, malaise, anemia, thrush. Adverse effects lasted until day of death.


Changed on 7/7/2013

VAERS ID: 476377 Before After
VAERS Form:
Age:89.0
Sex:Female
Location:New York
Vaccinated:2012-10-02
Onset:2012-10-14
Submitted:2012-12-04
Entered:2012-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4489AA / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4489AA / - LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Anaemia, Blood culture, Candidiasis, Chest X-ray, Computerised tomogram, Culture urine, Death, Echocardiogram, Fatigue, Full blood count, Hyperhidrosis, Malaise, Pyrexia, Ultrasound scan, Urine analysis, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-30
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg, Metoprolol ER 25mg, Isosorbide mononitrate 60mg, Fluoxetine 20mg, Hydrocodone/APAP 7.5/500, Omeprazole 20mg, ASA 81mg, Lidoderm patch 5%, Pravastatin 40mg.
Current Illness: None specifically known.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data: Blood cultures, blood analysis (CBC, etc), urine cultures and analysis, CT scans, chest x-rays, sonogram, echo-cardiogram, and possibly more tests were given.
CDC 'Split Type':

Write-up: Fevers (102.6 max), sweating, fatigue, malaise, anemia, thrush. Adverse effects lasted until day of death.


Changed on 6/14/2014

VAERS ID: 476377 Before After
VAERS Form:
Age:89.0
Sex:Female
Location:New York
Vaccinated:2012-10-02
Onset:2012-10-14
Submitted:2012-12-04
Entered:2012-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4489AA / - LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Anaemia, Blood culture, Candidiasis, Chest X-ray, Computerised tomogram, Culture urine, Death, Echocardiogram, Fatigue, Full blood count, Hyperhidrosis, Malaise, Pyrexia, Ultrasound scan, Urine analysis, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-30
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg, Metoprolol ER 25mg, Isosorbide mononitrate 60mg, Fluoxetine 20mg, Hydrocodone/APAP 7.5/500, Omeprazole 20mg, ASA 81mg, Lidoderm patch 5%, Pravastatin 40mg.
Current Illness: None specifically known.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data: Blood cultures, blood analysis (CBC, etc), urine cultures and analysis, CT scans, chest x-rays, sonogram, echo-cardiogram, and possibly more tests were given.
CDC 'Split Type':

Write-up: Fevers (102.6 max), sweating, fatigue, malaise, anemia, thrush. Adverse effects lasted until day of death.


Changed on 3/14/2015

VAERS ID: 476377 Before After
VAERS Form:
Age:89.0
Sex:Female
Location:New York
Vaccinated:2012-10-02
Onset:2012-10-14
Submitted:2012-12-04
Entered:2012-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4489AA / - LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Anaemia, Blood culture, Candidiasis, Chest X-ray, Computerised tomogram, Culture urine, Death, Echocardiogram, Fatigue, Full blood count, Hyperhidrosis, Malaise, Pyrexia, Ultrasound scan, Urine analysis, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-30
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg, Metoprolol ER 25mg, Isosorbide mononitrate 60mg, Fluoxetine 20mg, Hydrocodone/APAP 7.5/500, Omeprazole 20mg, ASA 81mg, Lidoderm patch 5%, Pravastatin 40mg.
Current Illness: None specifically known.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data: Blood cultures, blood analysis (CBC, etc), urine cultures and analysis, CT scans, chest x-rays, sonogram, echo-cardiogram, and possibly more tests were given.
CDC 'Split Type':

Write-up: Fevers (102.6 max), sweating, fatigue, malaise, anemia, thrush. Adverse effects lasted until day of death.


Changed on 9/14/2017

VAERS ID: 476377 Before After
VAERS Form:(blank) 1
Age:89.0
Sex:Female
Location:New York
Vaccinated:2012-10-02
Onset:2012-10-14
Submitted:2012-12-04
Entered:2012-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4489AA / - UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Anaemia, Blood culture, Candidiasis, Chest X-ray, Computerised tomogram, Culture urine, Death, Echocardiogram, Fatigue, Full blood count, Hyperhidrosis, Malaise, Pyrexia, Ultrasound scan, Urine analysis, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-30
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg, Metoprolol ER 25mg, Isosorbide mononitrate 60mg, Fluoxetine 20mg, Hydrocodone/APAP 7.5/500, Omeprazole 20mg, ASA 81mg, Lidoderm patch 5%, Pravastatin 40mg.
Current Illness: None specifically known.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data: Blood cultures, blood analysis (CBC, etc), urine cultures and analysis, CT scans, chest x-rays, sonogram, echo-cardiogram, and possibly more tests were given.
CDC 'Split Type':

Write-up: Fevers (102.6 max), sweating, fatigue, malaise, anemia, thrush. Adverse effects lasted until day of death.


Changed on 2/14/2018

VAERS ID: 476377 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:New York
Vaccinated:2012-10-02
Onset:2012-10-14
Submitted:2012-12-04
Entered:2012-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4489AA / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Anaemia, Blood culture, Candidiasis, Chest X-ray, Computerised tomogram, Culture urine, Death, Echocardiogram, Fatigue, Full blood count, Hyperhidrosis, Malaise, Pyrexia, Ultrasound scan, Urine analysis, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-30
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg, Metoprolol ER 25mg, Isosorbide mononitrate 60mg, Fluoxetine 20mg, Hydrocodone/APAP 7.5/500, Omeprazole 20mg, ASA 81mg, Lidoderm patch 5%, Pravastatin 40mg.
Current Illness: None specifically known.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data: Blood cultures, blood analysis (CBC, etc), urine cultures and analysis, CT scans, chest x-rays, sonogram, echo-cardiogram, and possibly more tests were given.
CDC 'Split Type':

Write-up: Fevers (102.6 max), sweating, fatigue, malaise, anemia, thrush. Adverse effects lasted until day of death.


Changed on 6/14/2018

VAERS ID: 476377 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:New York
Vaccinated:2012-10-02
Onset:2012-10-14
Submitted:2012-12-04
Entered:2012-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4489AA / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Anaemia, Blood culture, Candidiasis, Chest X-ray, Computerised tomogram, Culture urine, Death, Echocardiogram, Fatigue, Full blood count, Hyperhidrosis, Malaise, Pyrexia, Ultrasound scan, Urine analysis, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-30
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg, Metoprolol ER 25mg, Isosorbide mononitrate 60mg, Fluoxetine 20mg, Hydrocodone/APAP 7.5/500, Omeprazole 20mg, ASA 81mg, Lidoderm patch 5%, Pravastatin 40mg.
Current Illness: None specifically known.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data: Blood cultures, blood analysis (CBC, etc), urine cultures and analysis, CT scans, chest x-rays, sonogram, echo-cardiogram, and possibly more tests were given.
CDC 'Split Type':

Write-up: Fevers (102.6 max), sweating, fatigue, malaise, anemia, thrush. Adverse effects lasted until day of death.


Changed on 8/14/2018

VAERS ID: 476377 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:New York
Vaccinated:2012-10-02
Onset:2012-10-14
Submitted:2012-12-04
Entered:2012-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4489AA / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Anaemia, Blood culture, Candidiasis, Chest X-ray, Computerised tomogram, Culture urine, Death, Echocardiogram, Fatigue, Full blood count, Hyperhidrosis, Malaise, Pyrexia, Ultrasound scan, Urine analysis, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-30
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg, Metoprolol ER 25mg, Isosorbide mononitrate 60mg, Fluoxetine 20mg, Hydrocodone/APAP 7.5/500, Omeprazole 20mg, ASA 81mg, Lidoderm patch 5%, Pravastatin 40mg.
Current Illness: None specifically known.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data: Blood cultures, blood analysis (CBC, etc), urine cultures and analysis, CT scans, chest x-rays, sonogram, echo-cardiogram, and possibly more tests were given.
CDC 'Split Type':

Write-up: Fevers (102.6 max), sweating, fatigue, malaise, anemia, thrush. Adverse effects lasted until day of death.


Changed on 9/14/2018

VAERS ID: 476377 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:New York
Vaccinated:2012-10-02
Onset:2012-10-14
Submitted:2012-12-04
Entered:2012-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4489AA / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Anaemia, Blood culture, Candidiasis, Chest X-ray, Computerised tomogram, Culture urine, Death, Echocardiogram, Fatigue, Full blood count, Hyperhidrosis, Malaise, Pyrexia, Ultrasound scan, Urine analysis, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-30
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg, Metoprolol ER 25mg, Isosorbide mononitrate 60mg, Fluoxetine 20mg, Hydrocodone/APAP 7.5/500, Omeprazole 20mg, ASA 81mg, Lidoderm patch 5%, Pravastatin 40mg.
Current Illness: None specifically known.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data: Blood cultures, blood analysis (CBC, etc), urine cultures and analysis, CT scans, chest x-rays, sonogram, echo-cardiogram, and possibly more tests were given.
CDC 'Split Type':

Write-up: Fevers (102.6 max), sweating, fatigue, malaise, anemia, thrush. Adverse effects lasted until day of death.


Changed on 10/14/2018

VAERS ID: 476377 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:New York
Vaccinated:2012-10-02
Onset:2012-10-14
Submitted:2012-12-04
Entered:2012-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4489AA / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Anaemia, Blood culture, Candidiasis, Chest X-ray, Computerised tomogram, Culture urine, Death, Echocardiogram, Fatigue, Full blood count, Hyperhidrosis, Malaise, Pyrexia, Ultrasound scan, Urine analysis, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-30
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg, Metoprolol ER 25mg, Isosorbide mononitrate 60mg, Fluoxetine 20mg, Hydrocodone/APAP 7.5/500, Omeprazole 20mg, ASA 81mg, Lidoderm patch 5%, Pravastatin 40mg.
Current Illness: None specifically known.
Preexisting Conditions: None known.
Allergies:
Diagnostic Lab Data: Blood cultures, blood analysis (CBC, etc), urine cultures and analysis, CT scans, chest x-rays, sonogram, echo-cardiogram, and possibly more tests were given.
CDC 'Split Type':

Write-up: Fevers (102.6 max), sweating, fatigue, malaise, anemia, thrush. Adverse effects lasted until day of death.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=476377&WAYBACKHISTORY=ON


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