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This is VAERS ID 483215

History of Changes from the VAERS Wayback Machine

First Appeared on 2/13/2013

VAERS ID: 483215
VAERS Form:
Age:2.0
Sex:Female
Location:Minnesota
Vaccinated:2013-01-16
Onset:2013-01-17
Submitted:2013-02-01
Entered:2013-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AL2156 / 3 - / IN

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-17
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:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient deceased.


Changed on 7/7/2013

VAERS ID: 483215 Before After
VAERS Form:
Age:2.0
Sex:Female
Location:Minnesota
Vaccinated:2013-01-16
Onset:2013-01-17
Submitted:2013-02-01
Entered:2013-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AL2156 / 3 - / IN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AL2156 / 3 - / IN

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-17
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:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient deceased.


Changed on 9/17/2013

VAERS ID: 483215 Before After
VAERS Form:
Age:2.0
Sex:Female
Location:Minnesota
Vaccinated:2013-01-16
Onset:2013-01-17
Submitted:2013-02-01
Entered:2013-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AL2156 / 3 - / IN

Administered by: Private      Purchased by: Private
Symptoms: Aspartate aminotransferase increased, Basophil count increased, Blood calcium decreased, Blood culture negative, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Blood potassium increased, Blood pressure decreased, Blood pressure increased, Convulsion, Cough, CSF culture negative, Death, Influenza, Lethargy, Lymphocyte count increased, Malaise, Monocyte count increased, Muscle twitching, Oxygen saturation decreased, Pyrexia, Red blood cells urine positive, Respiratory failure, Respiratory rate decreased, Resuscitation, Rhonchi, Viral infection, Vomiting, White blood cell count increased, Postictal state, Specific gravity urine increased, Tonic clonic movements, Sputum culture positive, Basophil percentage increased, Neutrophil percentage decreased, Monocyte percentage increased, Lymphocyte percentage increased, Pharyngeal erythema, Urine odour abnormal, Urine ketone body present, Breath sounds abnormal, Endotracheal intubation, Oropharyngeal pain, Streptococcus test positive, Influenza B virus test positive, Influenza A virus test positive, Streptococcus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-17
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:
Current Illness: No The following information was obtained through follow-up and/or provided by the government. Family member w/ flu.
Preexisting Conditions: The following information was obtained through follow-up and/or provided by the government. 2nd hand cigarrette smoke exposure in home.
Allergies:
Diagnostic Lab Data: The following information was obtained through follow-up and/or provided by the government. 2/11/2013 lab/diagnostic records received for DOS 1/17-18/2013. Strep, blood cx (-). Blood: WBC 19.2 K/uL (H), neutros 38.1% (L), lymphocytes 45.2% & 8.7 K/uL (H), monocytes 9.9% & 1.9 K/uL (H), basophils 6.8% & 1.3 K/uL (H), Ca 8.7 mg/dL (L), K 7.3 mEq/L (H), glucose 226 mg/dL (H), AST 96 U/L (H), lactic acid 2.9 mmol/L (H). UA: sp gravity $g1.03 (H), RBC 5-10 (H), ketones $g160 (H). Blood gas abnormal. 2/11/2013 autopsy lab/diagnostic records received for DOS 1/19-21/2013. Flu A/B (+). Lung cx (+) for gamma & alpha strep, gram + cocci. CSF cx (-).
CDC 'Split Type':

Write-up: Patient deceased. The following information was obtained through follow-up and/or provided by the government. 2/11/2013 ER records received for DOS 1/17/2013. Dx: viral syndrome. Pt w/ 2 day hx fevers, cough, sore throat, vomiting, 1 episode of feeling "droopy", foul smelling urine. PE: fever, mild erythema pharynx. Tx''d @ home w/ alternating ibuprofen & acetaminophen. D/c''d home w/ care & f/u instructions. 2/11/2013 ER records received for DOS 1/18/2013. Impression: 1) seizure, likely febrile in nature; 2) pulmonary failure w/ unsuccessful resuscitation efforts, suspect underlying fulminate influenza infection. Pt developed 1 min seizure. EMS activated. Upon arrival no longer seizing, pt transported to ER. PE: fever (102 F), postictal, lethargic, elevated BP, decreased air entry to lung bases. Tx''t: ice packs to neck & groin, acetaminophen, IVF. Temperature dropped to 99-100 F, lt foot began twitching, followed by tonic clonic activity. Tx''t: diazepam. Seizure activity lasted <1 min. Pt to be intubated & transferred for higher level care. BP dropping, respirations slowed, O2 sats 70-80%; followed by respiratory failure. Intubated, rhonchi noted, CPR performed. Lungs developed progressively more rhonchi. CPR stopped, death declared. 3/6 & 14/2013 autopsy report received for DOS 1/19/2013, DOD 1/18/2013. COD: seizure activity. Final Dx: clinical hx of seizure activity w/ associated respiratory arrest & death, febrile state 2^ to influenza.


Changed on 3/14/2015

VAERS ID: 483215 Before After
VAERS Form:
Age:2.0
Sex:Female
Location:Minnesota
Vaccinated:2013-01-16
Onset:2013-01-17
Submitted:2013-02-01
Entered:2013-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AL2156 / 3 - / IN

Administered by: Private      Purchased by: Private
Symptoms: Aspartate aminotransferase increased, Basophil count increased, Blood calcium decreased, Blood culture negative, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Blood potassium increased, Blood pressure decreased, Blood pressure increased, Convulsion, Cough, CSF culture negative, Death, Influenza, Lethargy, Lymphocyte count increased, Malaise, Monocyte count increased, Muscle twitching, Oxygen saturation decreased, Pyrexia, Red blood cells urine positive, Respiratory failure, Respiratory rate decreased, Resuscitation, Rhonchi, Viral infection, Vomiting, White blood cell count increased, Postictal state, Specific gravity urine increased, Tonic clonic movements, Sputum culture positive, Basophil percentage increased, Neutrophil percentage decreased, Monocyte percentage increased, Lymphocyte percentage increased, Pharyngeal erythema, Urine odour abnormal, Urine ketone body present, Breath sounds abnormal, Endotracheal intubation, Oropharyngeal pain, Streptococcus test positive, Influenza B virus test positive, Influenza A virus test positive, Streptococcus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-17
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:
Current Illness: No The following information was obtained through follow-up and/or provided by the government. Family member w/ flu.
Preexisting Conditions: The following information was obtained through follow-up and/or provided by the government. 2nd hand cigarrette smoke exposure in home.
Allergies:
Diagnostic Lab Data: The following information was obtained through follow-up and/or provided by the government. 2/11/2013 lab/diagnostic records received for DOS 1/17-18/2013. Strep, blood cx (-). Blood: WBC 19.2 K/uL (H), neutros 38.1% (L), lymphocytes 45.2% & 8.7 K/uL (H), monocytes 9.9% & 1.9 K/uL (H), basophils 6.8% & 1.3 K/uL (H), Ca 8.7 mg/dL (L), K 7.3 mEq/L (H), glucose 226 mg/dL (H), AST 96 U/L (H), lactic acid 2.9 mmol/L (H). UA: sp gravity $g1.03 (H), RBC 5-10 (H), ketones $g160 (H). Blood gas abnormal. 2/11/2013 autopsy lab/diagnostic records received for DOS 1/19-21/2013. Flu A/B (+). Lung cx (+) for gamma & alpha strep, gram + cocci. CSF cx (-).
CDC 'Split Type':

Write-up: Patient deceased. The following information was obtained through follow-up and/or provided by the government. 2/11/2013 ER records received for DOS 1/17/2013. Dx: viral syndrome. Pt w/ 2 day hx fevers, cough, sore throat, vomiting, 1 episode of feeling "droopy", foul smelling urine. PE: fever, mild erythema pharynx. Tx''d @ home w/ alternating ibuprofen & acetaminophen. D/c''d home w/ care & f/u instructions. 2/11/2013 ER records received for DOS 1/18/2013. Impression: 1) seizure, likely febrile in nature; 2) pulmonary failure w/ unsuccessful resuscitation efforts, suspect underlying fulminate influenza infection. Pt developed 1 min seizure. EMS activated. Upon arrival no longer seizing, pt transported to ER. PE: fever (102 F), postictal, lethargic, elevated BP, decreased air entry to lung bases. Tx''t: ice packs to neck & groin, acetaminophen, IVF. Temperature dropped to 99-100 F, lt foot began twitching, followed by tonic clonic activity. Tx''t: diazepam. Seizure activity lasted <1 min. Pt to be intubated & transferred for higher level care. BP dropping, respirations slowed, O2 sats 70-80%; followed by respiratory failure. Intubated, rhonchi noted, CPR performed. Lungs developed progressively more rhonchi. CPR stopped, death declared. 3/6 & 14/2013 autopsy report received for DOS 1/19/2013, DOD 1/18/2013. COD: seizure activity. Final Dx: clinical hx of seizure activity w/ associated respiratory arrest & death, febrile state 2^ to influenza.


Changed on 9/14/2017

VAERS ID: 483215 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Female
Location:Minnesota
Vaccinated:2013-01-16
Onset:2013-01-17
Submitted:2013-02-01
Entered:2013-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AL2156 / 3 4 - NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-17
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:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient deceased.


Changed on 2/14/2018

VAERS ID: 483215 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Minnesota
Vaccinated:2013-01-16
Onset:2013-01-17
Submitted:2013-02-01
Entered:2013-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AL2156 / 4 NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-17
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:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient deceased.


Changed on 6/14/2018

VAERS ID: 483215 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Minnesota
Vaccinated:2013-01-16
Onset:2013-01-17
Submitted:2013-02-01
Entered:2013-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AL2156 / 4 NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-17
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:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient deceased.


Changed on 8/14/2018

VAERS ID: 483215 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Minnesota
Vaccinated:2013-01-16
Onset:2013-01-17
Submitted:2013-02-01
Entered:2013-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AL2156 / 4 NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-17
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:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient deceased.


Changed on 9/14/2018

VAERS ID: 483215 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Minnesota
Vaccinated:2013-01-16
Onset:2013-01-17
Submitted:2013-02-01
Entered:2013-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AL2156 / 4 NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-17
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:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient deceased.


Changed on 10/14/2018

VAERS ID: 483215 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Minnesota
Vaccinated:2013-01-16
Onset:2013-01-17
Submitted:2013-02-01
Entered:2013-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AL2156 / 4 NS / IN

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-17
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:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient deceased.

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