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This is VAERS ID 478216

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2013

VAERS ID: 478216
VAERS Form:
Age:91.0
Sex:Male
Location:Virginia
Vaccinated:2012-11-19
Onset:2012-11-21
Submitted:2012-12-16
Entered:2012-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 0 LA / ID

Administered by: Unknown      Purchased by: Other
Symptoms: Chest X-ray, Cough, Dizziness, Headache, Pleural effusion, Pyrexia, Laboratory test, Increased bronchial secretion

Life Threatening? Yes
Birth Defect? No
Died? No
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: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Aenolol, prednisone Merck Sharpe, & D
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data: Chest x-rays, emergency room lab tests, extended hospital stage still going on.
CDC 'Split Type':

Write-up: Fluid in lungs, persistent rattling cough, excess mucous, headache, fever, dizziness, ....


Changed on 2/13/2013

VAERS ID: 478216 Before After
VAERS Form:
Age:91.0
Sex:Male
Location:Virginia
Vaccinated:2012-11-19
Onset:2012-11-21
Submitted:2012-12-16
Entered:2012-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 0 LA / ID

Administered by: Unknown      Purchased by: Other
Symptoms: Chest X-ray, Cough, Dizziness, Headache, Pleural effusion, Pyrexia, Laboratory test, Increased bronchial secretion

Life Threatening? Yes
Birth Defect? No
Died? No Yes
   Date died:0000-00-00
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: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Aenolol, prednisone Merck Sharpe, & D
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data: Chest x-rays, emergency room lab tests, extended hospital stage still going on.
CDC 'Split Type':

Write-up: Fluid in lungs, persistent rattling cough, excess mucous, headache, fever, dizziness, ....


Changed on 7/7/2013

VAERS ID: 478216 Before After
VAERS Form:
Age:91.0
Sex:Male
Location:Virginia
Vaccinated:2012-11-19
Onset:2012-11-21
Submitted:2012-12-16
Entered:2012-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 0 LA / ID
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 0 LA / ID

Administered by: Unknown      Purchased by: Other
Symptoms: Chest X-ray, Cough, Dizziness, Headache, Pleural effusion, Pyrexia, Laboratory test, Increased bronchial secretion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Aenolol, prednisone Merck Sharpe, & D
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data: Chest x-rays, emergency room lab tests, extended hospital stage still going on.
CDC 'Split Type':

Write-up: Fluid in lungs, persistent rattling cough, excess mucous, headache, fever, dizziness, ....


Changed on 6/14/2014

VAERS ID: 478216 Before After
VAERS Form:
Age:91.0
Sex:Male
Location:Virginia
Vaccinated:2012-11-19
Onset:2012-11-21
Submitted:2012-12-16
Entered:2012-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 0 LA / ID

Administered by: Unknown      Purchased by: Other
Symptoms: Chest X-ray, Cough, Dizziness, Headache, Pleural effusion, Pyrexia, Laboratory test, Increased bronchial secretion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Aenolol, prednisone Merck Sharpe, & D
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data: Chest x-rays, emergency room lab tests, extended hospital stage still going on.
CDC 'Split Type':

Write-up: Fluid in lungs, persistent rattling cough, excess mucous, headache, fever, dizziness, ....


Changed on 3/14/2015

VAERS ID: 478216 Before After
VAERS Form:
Age:91.0
Sex:Male
Location:Virginia
Vaccinated:2012-11-19
Onset:2012-11-21
Submitted:2012-12-16
Entered:2012-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 0 LA / ID

Administered by: Unknown      Purchased by: Other
Symptoms: Chest X-ray, Cough, Dizziness, Headache, Pleural effusion, Pyrexia, Laboratory test, Increased bronchial secretion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Aenolol, prednisone Merck Sharpe, & D
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data: Chest x-rays, emergency room lab tests, extended hospital stage still going on.
CDC 'Split Type':

Write-up: Fluid in lungs, persistent rattling cough, excess mucous, headache, fever, dizziness, ....


Changed on 9/14/2017

VAERS ID: 478216 Before After
VAERS Form:(blank) 1
Age:91.0
Sex:Male
Location:Virginia
Vaccinated:2012-11-19
Onset:2012-11-21
Submitted:2012-12-16
Entered:2012-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 0 1 LA / ID

Administered by: Unknown      Purchased by: Other
Symptoms: Chest X-ray, Cough, Dizziness, Headache, Pleural effusion, Pyrexia, Laboratory test, Increased bronchial secretion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Aenolol, prednisone Merck Sharpe, & D
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data: Chest x-rays, emergency room lab tests, extended hospital stage still going on.
CDC 'Split Type':

Write-up: Fluid in lungs, persistent rattling cough, excess mucous, headache, fever, dizziness, ....


Changed on 2/14/2018

VAERS ID: 478216 Before After
VAERS Form:1
Age:91.0
Sex:Male
Location:Virginia
Vaccinated:2012-11-19
Onset:2012-11-21
Submitted:2012-12-16
Entered:2012-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 1 LA / ID

Administered by: Unknown      Purchased by: Other
Symptoms: Chest X-ray, Cough, Dizziness, Headache, Pleural effusion, Pyrexia, Laboratory test, Increased bronchial secretion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Aenolol, prednisone Merck Sharpe, & D
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data: Chest x-rays, emergency room lab tests, extended hospital stage still going on.
CDC 'Split Type':

Write-up: Fluid in lungs, persistent rattling cough, excess mucous, headache, fever, dizziness, ....


Changed on 6/14/2018

VAERS ID: 478216 Before After
VAERS Form:1
Age:91.0
Sex:Male
Location:Virginia
Vaccinated:2012-11-19
Onset:2012-11-21
Submitted:2012-12-16
Entered:2012-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 1 LA / ID

Administered by: Unknown      Purchased by: Other
Symptoms: Chest X-ray, Cough, Dizziness, Headache, Pleural effusion, Pyrexia, Laboratory test, Increased bronchial secretion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Aenolol, prednisone Merck Sharpe, & D
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data: Chest x-rays, emergency room lab tests, extended hospital stage still going on.
CDC 'Split Type':

Write-up: Fluid in lungs, persistent rattling cough, excess mucous, headache, fever, dizziness, ....


Changed on 8/14/2018

VAERS ID: 478216 Before After
VAERS Form:1
Age:91.0
Sex:Male
Location:Virginia
Vaccinated:2012-11-19
Onset:2012-11-21
Submitted:2012-12-16
Entered:2012-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 1 LA / ID

Administered by: Unknown      Purchased by: Other
Symptoms: Chest X-ray, Cough, Dizziness, Headache, Pleural effusion, Pyrexia, Laboratory test, Increased bronchial secretion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Aenolol, prednisone Merck Sharpe, & D
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data: Chest x-rays, emergency room lab tests, extended hospital stage still going on.
CDC 'Split Type':

Write-up: Fluid in lungs, persistent rattling cough, excess mucous, headache, fever, dizziness, ....


Changed on 9/14/2018

VAERS ID: 478216 Before After
VAERS Form:1
Age:91.0
Sex:Male
Location:Virginia
Vaccinated:2012-11-19
Onset:2012-11-21
Submitted:2012-12-16
Entered:2012-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 1 LA / ID

Administered by: Unknown      Purchased by: Other
Symptoms: Chest X-ray, Cough, Dizziness, Headache, Pleural effusion, Pyrexia, Laboratory test, Increased bronchial secretion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Aenolol, prednisone Merck Sharpe, & D
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data: Chest x-rays, emergency room lab tests, extended hospital stage still going on.
CDC 'Split Type':

Write-up: Fluid in lungs, persistent rattling cough, excess mucous, headache, fever, dizziness, ....


Changed on 10/14/2018

VAERS ID: 478216 Before After
VAERS Form:1
Age:91.0
Sex:Male
Location:Virginia
Vaccinated:2012-11-19
Onset:2012-11-21
Submitted:2012-12-16
Entered:2012-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED 0793510 / 1 LA / ID

Administered by: Unknown      Purchased by: Other
Symptoms: Chest X-ray, Cough, Dizziness, Headache, Pleural effusion, Pyrexia, Laboratory test, Increased bronchial secretion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 8     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Aenolol, prednisone Merck Sharpe, & D
Current Illness: No
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data: Chest x-rays, emergency room lab tests, extended hospital stage still going on.
CDC 'Split Type':

Write-up: Fluid in lungs, persistent rattling cough, excess mucous, headache, fever, dizziness, ....

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