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This is VAERS ID 480995

History of Changes from the VAERS Wayback Machine

First Appeared on 2/13/2013

VAERS ID: 480995
VAERS Form:
Age:78.0
Sex:Female
Location:Nebraska
Vaccinated:2012-10-03
Onset:2012-10-07
Submitted:2013-01-10
Entered:2013-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH730AB / - LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Guillain-Barre syndrome, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-18
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes; Coronary artery disease; Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine 10-3-12. To ER 10-12-12 with (L) arm pain. Seen 10-13-12 & transferred to cardiologist at hospital she declined there, was diagnosed with Guillain-Barre, transferred to where she expired.


Changed on 7/7/2013

VAERS ID: 480995 Before After
VAERS Form:
Age:78.0
Sex:Female
Location:Nebraska
Vaccinated:2012-10-03
Onset:2012-10-07
Submitted:2013-01-10
Entered:2013-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH730AB / - LA / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH730AB / - LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Guillain-Barre syndrome, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-18
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes; Coronary artery disease; Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine 10-3-12. To ER 10-12-12 with (L) arm pain. Seen 10-13-12 & transferred to cardiologist at hospital she declined there, was diagnosed with Guillain-Barre, transferred to where she expired.


Changed on 9/14/2017

VAERS ID: 480995 Before After
VAERS Form:(blank) 1
Age:78.0
Sex:Female
Location:Nebraska
Vaccinated:2012-10-03
Onset:2012-10-07
Submitted:2013-01-10
Entered:2013-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH730AB / - UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Guillain-Barre syndrome, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-18
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes; Coronary artery disease; Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine 10-3-12. To ER 10-12-12 with (L) arm pain. Seen 10-13-12 & transferred to cardiologist at hospital she declined there, was diagnosed with Guillain-Barre, transferred to where she expired.


Changed on 2/14/2018

VAERS ID: 480995 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Nebraska
Vaccinated:2012-10-03
Onset:2012-10-07
Submitted:2013-01-10
Entered:2013-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH730AB / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Guillain-Barre syndrome, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-18
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes; Coronary artery disease; Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine 10-3-12. To ER 10-12-12 with (L) arm pain. Seen 10-13-12 & transferred to cardiologist at hospital she declined there, was diagnosed with Guillain-Barre, transferred to where she expired.


Changed on 6/14/2018

VAERS ID: 480995 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Nebraska
Vaccinated:2012-10-03
Onset:2012-10-07
Submitted:2013-01-10
Entered:2013-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH730AB / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Guillain-Barre syndrome, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-18
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes; Coronary artery disease; Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine 10-3-12. To ER 10-12-12 with (L) arm pain. Seen 10-13-12 & transferred to cardiologist at hospital she declined there, was diagnosed with Guillain-Barre, transferred to where she expired.


Changed on 8/14/2018

VAERS ID: 480995 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Nebraska
Vaccinated:2012-10-03
Onset:2012-10-07
Submitted:2013-01-10
Entered:2013-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH730AB / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Guillain-Barre syndrome, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-18
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes; Coronary artery disease; Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine 10-3-12. To ER 10-12-12 with (L) arm pain. Seen 10-13-12 & transferred to cardiologist at hospital she declined there, was diagnosed with Guillain-Barre, transferred to where she expired.


Changed on 9/14/2018

VAERS ID: 480995 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Nebraska
Vaccinated:2012-10-03
Onset:2012-10-07
Submitted:2013-01-10
Entered:2013-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH730AB / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Guillain-Barre syndrome, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-18
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes; Coronary artery disease; Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine 10-3-12. To ER 10-12-12 with (L) arm pain. Seen 10-13-12 & transferred to cardiologist at hospital she declined there, was diagnosed with Guillain-Barre, transferred to where she expired.


Changed on 10/14/2018

VAERS ID: 480995 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Nebraska
Vaccinated:2012-10-03
Onset:2012-10-07
Submitted:2013-01-10
Entered:2013-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH730AB / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Guillain-Barre syndrome, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-18
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes; Coronary artery disease; Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine 10-3-12. To ER 10-12-12 with (L) arm pain. Seen 10-13-12 & transferred to cardiologist at hospital she declined there, was diagnosed with Guillain-Barre, transferred to where she expired.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=480995&WAYBACKHISTORY=ON


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