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This is VAERS ID 47668

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 47668
VAERS Form:
Age:70.1
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1992-1993 / WYETH 4928202 / 0 LA / -
PPV: PNU-IMUNE(R)23 / LEDERLE 308913 / 0 RA / -

Administered by: Public      Purchased by: Unknown
Symptoms: HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE

Write-up: pt had massive coronary & died on 21OCT92;


Changed on 12/8/2009

VAERS ID: 47668 Before After
VAERS Form:
Age:70.1
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-08 1992-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1992-1993 INFLUENZA (SEASONAL) (NO BRAND NAME, 92-93) / WYETH WYETH PHARMACEUTICALS, INC 4928202 / 0 LA / -
PPV: PNU-IMUNE(R)23 PNEUMO (PNU-IMUNE) / LEDERLE LEDERLE LABORATORIES 308913 / 0 RA / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Cardiac arrest, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE MS9256

Write-up: pt had massive coronary & died on 21OCT92;


Changed on 8/31/2010

VAERS ID: 47668 Before After
VAERS Form:
Age:70.1
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 92-93) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4928202 / 0 LA / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 308913 / 0 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MS9256

Write-up: pt had massive coronary & died on 21OCT92;


Changed on 7/7/2013

VAERS ID: 47668 Before After
VAERS Form:
Age:70.1
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 0 LA / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 0 LA / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 308913 / 0 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MS9256

Write-up: pt had massive coronary & died on 21OCT92;


Changed on 12/14/2016

VAERS ID: 47668 Before After
VAERS Form:
Age:70.1
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 0 LA / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 0 LA / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 308913 / 0 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MS9256

Write-up: pt had massive coronary & died on 21OCT92;


Changed on 2/14/2017

VAERS ID: 47668 Before After
VAERS Form:
Age:70.1 70.0
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 0 LA / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 308913 / 0 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MS9256

Write-up: pt had massive coronary & died on 21OCT92;


Changed on 5/14/2017

VAERS ID: 47668 Before After
VAERS Form:
Age:70.0
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 0 LA / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 308913 / 0 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MS9256

Write-up: pt had massive coronary & died on 21OCT92;


Changed on 9/14/2017

VAERS ID: 47668 Before After
VAERS Form:(blank) 1
Age:70.0
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 0 1 LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308913 / 0 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MS9256

Write-up: pt had massive coronary & died on 21OCT92;


Changed on 2/14/2018

VAERS ID: 47668 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 1 LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308913 / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MS9256

Write-up: pt had massive coronary & died on 21OCT92;


Changed on 6/14/2018

VAERS ID: 47668 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 1 LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308913 / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MS9256

Write-up: pt had massive coronary & died on 21OCT92;


Changed on 8/14/2018

VAERS ID: 47668 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 1 LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308913 / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MS9256

Write-up: pt had massive coronary & died on 21OCT92;


Changed on 9/14/2018

VAERS ID: 47668 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 1 LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308913 / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MS9256

Write-up: pt had massive coronary & died on 21OCT92;


Changed on 10/14/2018

VAERS ID: 47668 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Mississippi
Vaccinated:1992-10-09
Onset:1992-10-21
Submitted:1992-10-26
Entered:1992-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928202 / 1 LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308913 / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-10-21
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MS9256

Write-up: pt had massive coronary & died on 21OCT92;

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