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This is VAERS ID 486413

History of Changes from the VAERS Wayback Machine

First Appeared on 3/12/2013

VAERS ID: 486413
VAERS Form:
Age:49.0
Sex:Female
Location:Georgia
Vaccinated:2012-09-15
Onset:2012-09-15
Submitted:2013-03-07
Entered:2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Hypersomnia, Hypokinesia, Intensive care, Lethargy, Malaise, Vomiting, Abasia, Dysstasia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-10-01
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: couldnt move without assistance~ ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|~Influenza (Seasonal) (no brand name)~~0.00~Pa
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU
CDC 'Split Type':

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit.


Changed on 4/13/2013

VAERS ID: 486413 Before After
VAERS Form:
Age:49.0
Sex:Female
Location:Georgia
Vaccinated:2012-09-15 2012-09-14
Onset:2012-09-15
Submitted:2013-03-07
Entered:2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) INFLUENZA (SEASONAL) (FLUVIRIN) / UNKNOWN MANUFACTURER NOVARTIS VACCINES AND DIAGNOSTICS - 1204601 / - - LA / - IM

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Hypersomnia, Hypokinesia, Intensive care, Lethargy, Malaise, Vomiting, Abasia, Dysstasia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-10-01
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: couldnt move without assistance~ ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|~Influenza (Seasonal) (no brand name)~~0.00~Pa ()~~0.00~Patient|weakness~ ()~UN~12.75~Patient|~Influenza (Seas
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU
CDC 'Split Type':

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit.


Changed on 7/7/2013

VAERS ID: 486413 Before After
VAERS Form:
Age:49.0
Sex:Female
Location:Georgia
Vaccinated:2012-09-14
Onset:2012-09-15
Submitted:2013-03-07
Entered:2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204601 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204601 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Hypersomnia, Hypokinesia, Intensive care, Lethargy, Malaise, Vomiting, Abasia, Dysstasia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-10-01
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: couldnt move without assistance~ ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|weakness~ ()~UN~12.75~Patient|~Influenza (Seas
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU
CDC 'Split Type':

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit.


Changed on 9/17/2013

VAERS ID: 486413 Before After
VAERS Form:
Age:49.0
Sex:Female
Location:Georgia
Vaccinated:2012-09-14
Onset:2012-09-15
Submitted:2013-03-07
Entered:2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204601 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Activated partial thromboplastin time prolonged, Acute myocardial infarction, Acute respiratory failure, Anaemia, Atelectasis, Atrial fibrillation, Blood albumin decreased, Blood bilirubin increased, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase MB increased, Blood creatinine increased, Blood culture positive, Blood fibrinogen increased, Blood gases abnormal, Blood glucose increased, Blood magnesium decreased, Blood potassium decreased, Blood potassium increased, Blood sodium decreased, Blood urea increased, Computerised tomogram abnormal, Diarrhoea, Differential white blood cell count abnormal, Dilatation ventricular, Disseminated intravascular coagulation, Dyspnoea, Electrocardiogram abnormal, Encephalopathy, Endocarditis, Fibrin D dimer increased, Fluid overload, Haematocrit decreased, Haemoglobin decreased, Hypersomnia, Hypokinesia, Hypotension, Hypothermia, Intensive care, International normalised ratio increased, Laboratory test abnormal, Lethargy, Lung consolidation, Malaise, Miosis, Platelet count decreased, Pleural effusion, Pneumothorax, Protein total increased, Prothrombin time prolonged, Pulmonary hypertension, Red blood cells urine positive, Renal failure chronic, Sepsis, Septic shock, Subcutaneous emphysema, Thrombocytopenia, Urinary system X-ray, Urine abnormality, Vomiting, White blood cell count, White blood cells urine positive, X-ray abnormal, Mental status changes, Abasia, Blood phosphorus increased, Dysstasia, Blood urea nitrogen/creatinine ratio increased, Staphylococcal bacteraemia, Lymphocyte percentage decreased, Red cell distribution width increased, Computerised tomogram head, Ocular icterus, Troponin increased, Bacterial test positive, Blood alkaline phosphatase increased, Malnutrition, Echocardiogram abnormal, Adverse drug reaction, Red blood cell morphology abnormal, Procalcitonin increased, Mechanical ventilation, Right atrial dilatation, Endotracheal intubation, Heart valve incompetence, Pleural fluid analysis, Hyperdynamic left ventricle, Bacteroides test positive, Staphylococcus test positive, Hyporesponsive to stimuli, White matter lesion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-10-01
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: couldnt move without assistance~ ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|weakness~ ()~UN~12.75~Patient|~Influenza (Seas
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident. The following information was obtained through follow-up and/or provided by the government. 6/6/13 PMH: HIV. Endstage renal disease on dialysis, hypertension, diabetes mellitus, CVA. Paranoid schizophrenia. Non-adherence to medical therapy. Chronic thrombocytopenia. Allergies to Benadryl, penicillin and sulfa drugs.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU The following information was obtained through follow-up and/or provided by the government. 6/6/13 Labs and Diagnostics: Elevated cardiac markers. CT Brain - Abnormal, white matter changes. ECG - Abnormal, atrial fibrillation, rapid response, heart rate 140. Echocardiogram - Abnormal, pulmonary hypertension, right ventricular and atrial dilatation, tricuspid and aortic regurgitation. CHEM - Bilirubin 2.2 mg/dl (H) Alk Phos 187 U/L (H). 6/6/12 Labs and Diagnostics (Representative values): CHEM - Potassium 3.3 mEq/L (L) Glucose 219 mg/dl (H) BUN 35 (H) Creatinine 6.49 mg/dl (H) BUN/Creat Ratio 4.9 (L) Calcium 7.4 mg/dl (L) Procalcitonin I 38.38 (H) Sodium 131 mEq/L (L) Chloride 96 mEq/L (L) Potassium 5.5 mEq/L (H) Phospho
CDC 'Split Type':

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit. The following information was obtained through follow-up and/or provided by the government. 04/03/13 Death Certificate received. Final Cause of Death: Septic Shock, Aortic Valve Endocarditis. 6/6/13 Hospital records, consultations, and discharge summary received. Service dates 9/24/12 to 10/9/12. Diagnosis: Aortic valve endocarditis, Methicillin-sensitive Staph aureus bacteremia, Gram-negative rod bacteremia, sepsis, septic shock, acute respiratory failure, diarrhea, end-stage renal disease, inability to do hemodialysis secondary to hypotension on multiple pressors, HIV. Patient presented with altered mental status, coolness of body, lethargic, responding to noxious stimulus, fluid overload. Hyperdynamic precordium. Subsequently diagnoses with sepsis, septic shock and MSSA bacteremia, as well as AV valve endocarditis. Intensive care, respiratory failure, intubated and on ventilator. IV vancomycin, Levaquin, gentamicin. Could not be dialyzed. Atrial fibrillation, non-ST elevation myocardial infarction, anemia, thrombocytopenia. Pinpoint Pupils, malnutrition, encephalopathy, dyspnea, hypothermia, scleral icterus. Acute thrombocytopenia consistent with disseminated intravasular coagulopathy. Palliative care consultation - Patient was made a "status 2" subsequently "status 3", and care was withdrawn after which she passed away.


Changed on 3/14/2015

VAERS ID: 486413 Before After
VAERS Form:
Age:49.0
Sex:Female
Location:Georgia
Vaccinated:2012-09-14
Onset:2012-09-15
Submitted:2013-03-07
Entered:2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204601 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Activated partial thromboplastin time prolonged, Acute myocardial infarction, Acute respiratory failure, Anaemia, Atelectasis, Atrial fibrillation, Blood albumin decreased, Blood bilirubin increased, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase MB increased, Blood creatinine increased, Blood culture positive, Blood fibrinogen increased, Blood gases abnormal, Blood glucose increased, Blood magnesium decreased, Blood potassium decreased, Blood potassium increased, Blood sodium decreased, Blood urea increased, Computerised tomogram abnormal, Diarrhoea, Differential white blood cell count abnormal, Dilatation ventricular, Disseminated intravascular coagulation, Dyspnoea, Electrocardiogram abnormal, Encephalopathy, Endocarditis, Fibrin D dimer increased, Fluid overload, Haematocrit decreased, Haemoglobin decreased, Hypersomnia, Hypokinesia, Hypotension, Hypothermia, Intensive care, International normalised ratio increased, Laboratory test abnormal, Lethargy, Lung consolidation, Malaise, Miosis, Platelet count decreased, Pleural effusion, Pneumothorax, Protein total increased, Prothrombin time prolonged, Pulmonary hypertension, Red blood cells urine positive, Renal failure chronic, Sepsis, Septic shock, Subcutaneous emphysema, Thrombocytopenia, Urinary system X-ray, Urine abnormality, Vomiting, White blood cell count, White blood cells urine positive, X-ray abnormal, Mental status changes, Abasia, Blood phosphorus increased, Dysstasia, Blood urea nitrogen/creatinine ratio increased, Staphylococcal bacteraemia, Lymphocyte percentage decreased, Red cell distribution width increased, Computerised tomogram head, Ocular icterus, Troponin increased, Bacterial test positive, Blood alkaline phosphatase increased, Malnutrition, Echocardiogram abnormal, Adverse drug reaction, Red blood cell morphology abnormal, Procalcitonin increased, Mechanical ventilation, Right atrial dilatation, Endotracheal intubation, Heart valve incompetence, Pleural fluid analysis, Hyperdynamic left ventricle, Bacteroides test positive, Staphylococcus test positive, Hyporesponsive to stimuli, White matter lesion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-10-01
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: couldnt weakness~ ()~UN~12.75~Patient|~Influenza (Seasonal) (no brand name)~~0.00~Patient|couldnt move without assistance~ ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|weakness~ ()~UN~12.75~Patient|~Influenza (Seas ()~~0.00~Pati
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident. The following information was obtained through follow-up and/or provided by the government. 6/6/13 PMH: HIV. Endstage renal disease on dialysis, hypertension, diabetes mellitus, CVA. Paranoid schizophrenia. Non-adherence to medical therapy. Chronic thrombocytopenia. Allergies to Benadryl, penicillin and sulfa drugs.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU The following information was obtained through follow-up and/or provided by the government. 6/6/13 Labs and Diagnostics: Elevated cardiac markers. CT Brain - Abnormal, white matter changes. ECG - Abnormal, atrial fibrillation, rapid response, heart rate 140. Echocardiogram - Abnormal, pulmonary hypertension, right ventricular and atrial dilatation, tricuspid and aortic regurgitation. CHEM - Bilirubin 2.2 mg/dl (H) Alk Phos 187 U/L (H). 6/6/12 Labs and Diagnostics (Representative values): CHEM - Potassium 3.3 mEq/L (L) Glucose 219 mg/dl (H) BUN 35 (H) Creatinine 6.49 mg/dl (H) BUN/Creat Ratio 4.9 (L) Calcium 7.4 mg/dl (L) Procalcitonin I 38.38 (H) Sodium 131 mEq/L (L) Chloride 96 mEq/L (L) Potassium 5.5 mEq/L (H) Phospho
CDC 'Split Type':

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit. The following information was obtained through follow-up and/or provided by the government. 04/03/13 Death Certificate received. Final Cause of Death: Septic Shock, Aortic Valve Endocarditis. 6/6/13 Hospital records, consultations, and discharge summary received. Service dates 9/24/12 to 10/9/12. Diagnosis: Aortic valve endocarditis, Methicillin-sensitive Staph aureus bacteremia, Gram-negative rod bacteremia, sepsis, septic shock, acute respiratory failure, diarrhea, end-stage renal disease, inability to do hemodialysis secondary to hypotension on multiple pressors, HIV. Patient presented with altered mental status, coolness of body, lethargic, responding to noxious stimulus, fluid overload. Hyperdynamic precordium. Subsequently diagnoses with sepsis, septic shock and MSSA bacteremia, as well as AV valve endocarditis. Intensive care, respiratory failure, intubated and on ventilator. IV vancomycin, Levaquin, gentamicin. Could not be dialyzed. Atrial fibrillation, non-ST elevation myocardial infarction, anemia, thrombocytopenia. Pinpoint Pupils, malnutrition, encephalopathy, dyspnea, hypothermia, scleral icterus. Acute thrombocytopenia consistent with disseminated intravasular coagulopathy. Palliative care consultation - Patient was made a "status 2" subsequently "status 3", and care was withdrawn after which she passed away.


Changed on 2/14/2017

VAERS ID: 486413 Before After
VAERS Form:
Age:49.0
Sex:Female
Location:Georgia
Vaccinated:2012-09-14
Onset:2012-09-15
Submitted:2013-03-07
Entered:2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204601 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Hypersomnia, Hypokinesia, Intensive care, Lethargy, Malaise, Vomiting, Abasia, Dysstasia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-10-01
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: weakness~ ()~UN~12.75~Patient|~Influenza (Seasonal) (no brand name)~~0.00~Patient|couldnt couldnt move without assistance~ ()~~0.00~Pati ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|weakness~ ()~UN~12.75~Patient|~Influenza (Seas
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU
CDC 'Split Type':

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit.


Changed on 9/14/2017

VAERS ID: 486413 Before After
VAERS Form:(blank) 1
Age:49.0
Sex:Female
Location:Georgia
Vaccinated:2012-09-14
Onset:2012-09-15
Submitted:2013-03-07
Entered:2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204601 / - UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Hypersomnia, Hypokinesia, Intensive care, Lethargy, Malaise, Vomiting, Abasia, Dysstasia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-10-01
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: couldnt move without assistance~ ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|weakness~ ()~UN~12.75~Patient|~Influenza (Seas
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU
CDC 'Split Type':

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit.


Changed on 2/14/2018

VAERS ID: 486413 Before After
VAERS Form:1
Age:49.0
Sex:Female
Location:Georgia
Vaccinated:2012-09-14
Onset:2012-09-15
Submitted:2013-03-07
Entered:2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204601 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Hypersomnia, Hypokinesia, Intensive care, Lethargy, Malaise, Vomiting, Abasia, Dysstasia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-10-01
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: couldnt move without assistance~ ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|weakness~ ()~UN~12.75~Patient|~Influenza (Seas
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU
CDC 'Split Type':

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit.


Changed on 6/14/2018

VAERS ID: 486413 Before After
VAERS Form:1
Age:49.0
Sex:Female
Location:Georgia
Vaccinated:2012-09-14
Onset:2012-09-15
Submitted:2013-03-07
Entered:2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204601 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Hypersomnia, Hypokinesia, Intensive care, Lethargy, Malaise, Vomiting, Abasia, Dysstasia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-10-01
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: couldnt move without assistance~ ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|weakness~ ()~UN~12.75~Patient|~Influenza (Seas
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU
CDC 'Split Type':

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit.


Changed on 8/14/2018

VAERS ID: 486413 Before After
VAERS Form:1
Age:49.0
Sex:Female
Location:Georgia
Vaccinated:2012-09-14
Onset:2012-09-15
Submitted:2013-03-07
Entered:2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204601 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Hypersomnia, Hypokinesia, Intensive care, Lethargy, Malaise, Vomiting, Abasia, Dysstasia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-10-01
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: couldnt move without assistance~ ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|weakness~ ()~UN~12.75~Patient|~Influenza (Seas
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU
CDC 'Split Type':

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit.


Changed on 9/14/2018

VAERS ID: 486413 Before After
VAERS Form:1
Age:49.0
Sex:Female
Location:Georgia
Vaccinated:2012-09-14
Onset:2012-09-15
Submitted:2013-03-07
Entered:2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204601 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Hypersomnia, Hypokinesia, Intensive care, Lethargy, Malaise, Vomiting, Abasia, Dysstasia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-10-01
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: couldnt move without assistance~ ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|weakness~ ()~UN~12.75~Patient|~Influenza (Seas
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU
CDC 'Split Type':

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit.


Changed on 10/14/2018

VAERS ID: 486413 Before After
VAERS Form:1
Age:49.0
Sex:Female
Location:Georgia
Vaccinated:2012-09-14
Onset:2012-09-15
Submitted:2013-03-07
Entered:2013-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204601 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Hypersomnia, Hypokinesia, Intensive care, Lethargy, Malaise, Vomiting, Abasia, Dysstasia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2012-10-01
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: couldnt move without assistance~ ()~~0.00~Patient|couldnt stand~ ()~~0.00~Patient|weakness~ ()~UN~12.75~Patient|~Influenza (Seas
Other Medications: Duonebs, Abilify, Azactam, Carvedilol, Diflucan, Diflucan, Levanquin, Solu-Cortef, Synthroid, Vancomycin. Allergies: Sulfa, Penicillin, Benadryl
Current Illness: After an hour of vaccine, patient was nausea, vomiting, diarrhea and couldn''t move or stand to go to bathroom.
Preexisting Conditions: Received vaccine at dialysis center. Dialysis of kidney, full-blown AIDS, but very active and lively before incident.
Allergies:
Diagnostic Lab Data: Yes. ER & ICU & CCU
CDC 'Split Type':

Write-up: Stated she wasnt feeling well. I thought it was from dialysis treatment. She went to sleep, slept longer than normal, tried to eat, vomiting, couldn''t move or stand without assistance. Refused to go to hospital, diarrhea on herself, sleeping, couldn''t move off couch to bed, could walk, kept saying she was sick wanted. Very lethargic, no fever, got help from two sons to help move to wash off diarrhea & vomit.

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