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This is VAERS ID 480310

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2013

VAERS ID: 480310
VAERS Form:
Age:53.0
Sex:Female
Location:New York
Vaccinated:2012-12-19
Onset:2012-12-23
Submitted:2013-01-06
Entered:2013-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Malaise, Pericardial haemorrhage, Viral test, Bacterial test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-23
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: SPIRIVA; Gabapentin; Simvastatin; Diclofenac
Current Illness: None
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Viral and bacterial cultures of pericardial blood pending
CDC 'Split Type':

Write-up: According to son who was interrogated, decedent received flu vaccine 12/19 at hospital and was not feeling well after that; found dead at home 12/23, hemorrhagic pericarditis.


Changed on 7/7/2013

VAERS ID: 480310 Before After
VAERS Form:
Age:53.0
Sex:Female
Location:New York
Vaccinated:2012-12-19
Onset:2012-12-23
Submitted:2013-01-06
Entered:2013-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Malaise, Pericardial haemorrhage, Viral test, Bacterial test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-23
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: SPIRIVA; Gabapentin; Simvastatin; Diclofenac
Current Illness: None
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Viral and bacterial cultures of pericardial blood pending
CDC 'Split Type':

Write-up: According to son who was interrogated, decedent received flu vaccine 12/19 at hospital and was not feeling well after that; found dead at home 12/23, hemorrhagic pericarditis.


Changed on 6/14/2014

VAERS ID: 480310 Before After
VAERS Form:
Age:53.0
Sex:Female
Location:New York
Vaccinated:2012-12-19
Onset:2012-12-23
Submitted:2013-01-06
Entered:2013-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Malaise, Pericardial haemorrhage, Viral test, Bacterial test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-23
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: SPIRIVA; Gabapentin; Simvastatin; Diclofenac
Current Illness: None
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Viral and bacterial cultures of pericardial blood pending
CDC 'Split Type':

Write-up: According to son who was interrogated, decedent received flu vaccine 12/19 at hospital and was not feeling well after that; found dead at home 12/23, hemorrhagic pericarditis.


Changed on 3/14/2015

VAERS ID: 480310 Before After
VAERS Form:
Age:53.0
Sex:Female
Location:New York
Vaccinated:2012-12-19
Onset:2012-12-23
Submitted:2013-01-06
Entered:2013-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Malaise, Pericardial haemorrhage, Viral test, Bacterial test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-23
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: SPIRIVA; Gabapentin; Simvastatin; Diclofenac
Current Illness: None
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Viral and bacterial cultures of pericardial blood pending
CDC 'Split Type':

Write-up: According to son who was interrogated, decedent received flu vaccine 12/19 at hospital and was not feeling well after that; found dead at home 12/23, hemorrhagic pericarditis.


Changed on 12/14/2016

VAERS ID: 480310 Before After
VAERS Form:
Age:53.0
Sex:Female
Location:New York
Vaccinated:2012-12-19
Onset:2012-12-23
Submitted:2013-01-06
Entered:2013-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Malaise, Pericardial haemorrhage, Viral test, Bacterial test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-23
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: SPIRIVA; Gabapentin; Simvastatin; Diclofenac
Current Illness: None
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Viral and bacterial cultures of pericardial blood pending
CDC 'Split Type':

Write-up: According to son who was interrogated, decedent received flu vaccine 12/19 at hospital and was not feeling well after that; found dead at home 12/23, hemorrhagic pericarditis.


Changed on 9/14/2017

VAERS ID: 480310 Before After
VAERS Form:(blank) 1
Age:53.0
Sex:Female
Location:New York
Vaccinated:2012-12-19
Onset:2012-12-23
Submitted:2013-01-06
Entered:2013-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Malaise, Pericardial haemorrhage, Viral test, Bacterial test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-23
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: SPIRIVA; Gabapentin; Simvastatin; Diclofenac
Current Illness: None
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Viral and bacterial cultures of pericardial blood pending
CDC 'Split Type':

Write-up: According to son who was interrogated, decedent received flu vaccine 12/19 at hospital and was not feeling well after that; found dead at home 12/23, hemorrhagic pericarditis.


Changed on 2/14/2018

VAERS ID: 480310 Before After
VAERS Form:1
Age:53.0
Sex:Female
Location:New York
Vaccinated:2012-12-19
Onset:2012-12-23
Submitted:2013-01-06
Entered:2013-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Malaise, Pericardial haemorrhage, Viral test, Bacterial test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-23
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: SPIRIVA; Gabapentin; Simvastatin; Diclofenac
Current Illness: None
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Viral and bacterial cultures of pericardial blood pending
CDC 'Split Type':

Write-up: According to son who was interrogated, decedent received flu vaccine 12/19 at hospital and was not feeling well after that; found dead at home 12/23, hemorrhagic pericarditis.


Changed on 6/14/2018

VAERS ID: 480310 Before After
VAERS Form:1
Age:53.0
Sex:Female
Location:New York
Vaccinated:2012-12-19
Onset:2012-12-23
Submitted:2013-01-06
Entered:2013-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Malaise, Pericardial haemorrhage, Viral test, Bacterial test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-23
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: SPIRIVA; Gabapentin; Simvastatin; Diclofenac
Current Illness: None
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Viral and bacterial cultures of pericardial blood pending
CDC 'Split Type':

Write-up: According to son who was interrogated, decedent received flu vaccine 12/19 at hospital and was not feeling well after that; found dead at home 12/23, hemorrhagic pericarditis.


Changed on 8/14/2018

VAERS ID: 480310 Before After
VAERS Form:1
Age:53.0
Sex:Female
Location:New York
Vaccinated:2012-12-19
Onset:2012-12-23
Submitted:2013-01-06
Entered:2013-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Malaise, Pericardial haemorrhage, Viral test, Bacterial test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-23
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: SPIRIVA; Gabapentin; Simvastatin; Diclofenac
Current Illness: None
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Viral and bacterial cultures of pericardial blood pending
CDC 'Split Type':

Write-up: According to son who was interrogated, decedent received flu vaccine 12/19 at hospital and was not feeling well after that; found dead at home 12/23, hemorrhagic pericarditis.


Changed on 9/14/2018

VAERS ID: 480310 Before After
VAERS Form:1
Age:53.0
Sex:Female
Location:New York
Vaccinated:2012-12-19
Onset:2012-12-23
Submitted:2013-01-06
Entered:2013-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Malaise, Pericardial haemorrhage, Viral test, Bacterial test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-23
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: SPIRIVA; Gabapentin; Simvastatin; Diclofenac
Current Illness: None
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Viral and bacterial cultures of pericardial blood pending
CDC 'Split Type':

Write-up: According to son who was interrogated, decedent received flu vaccine 12/19 at hospital and was not feeling well after that; found dead at home 12/23, hemorrhagic pericarditis.


Changed on 10/14/2018

VAERS ID: 480310 Before After
VAERS Form:1
Age:53.0
Sex:Female
Location:New York
Vaccinated:2012-12-19
Onset:2012-12-23
Submitted:2013-01-06
Entered:2013-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Malaise, Pericardial haemorrhage, Viral test, Bacterial test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-23
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: SPIRIVA; Gabapentin; Simvastatin; Diclofenac
Current Illness: None
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: Viral and bacterial cultures of pericardial blood pending
CDC 'Split Type':

Write-up: According to son who was interrogated, decedent received flu vaccine 12/19 at hospital and was not feeling well after that; found dead at home 12/23, hemorrhagic pericarditis.

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