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This is VAERS ID 489391

History of Changes from the VAERS Wayback Machine

First Appeared on 5/13/2013

VAERS ID: 489391
VAERS Form:
Age:10.0
Sex:Female
Location:Tennessee
Vaccinated:2012-12-01
Onset:2013-03-20
Submitted:2013-04-15
Entered:2013-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Cardiac arrest, Chest pain, Death, Dyspnoea, Influenza, Life support, Myocarditis, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201304714

Write-up: Initial report was received on 08 April 2013 from an electronic lay press article. A 10-year-old female patient had received an injection of INFLUENZA VACCINE (trade name, manufacturer, lot number, route, site and exact date of administration not reported) in December 2012. The patient was diagnosed with strain B flu on 20 March 2013. Three days after the patient was diagnosed with the flu, she was rushed to the hospital after complaining of stomach and chest pains and difficulty breathing. She went into cardiac arrest the following morning, and doctors revived her after performing CPR for about two hours. She was placed on a life support system to restore oxygen to her blood. Doctors also put her on a machine to do the work of her heart while waiting for a transplant. The infection morphed into a serious case of myocarditis. The patient died from flu complications at 10:45 AM on 05 April 2013. Outcome was fatal. Documents held by sender: none.


Changed on 7/7/2013

VAERS ID: 489391 Before After
VAERS Form:
Age:10.0
Sex:Female
Location:Tennessee
Vaccinated:2012-12-01
Onset:2013-03-20
Submitted:2013-04-15
Entered:2013-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Cardiac arrest, Chest pain, Death, Dyspnoea, Influenza, Life support, Myocarditis, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201304714

Write-up: Initial report was received on 08 April 2013 from an electronic lay press article. A 10-year-old female patient had received an injection of INFLUENZA VACCINE (trade name, manufacturer, lot number, route, site and exact date of administration not reported) in December 2012. The patient was diagnosed with strain B flu on 20 March 2013. Three days after the patient was diagnosed with the flu, she was rushed to the hospital after complaining of stomach and chest pains and difficulty breathing. She went into cardiac arrest the following morning, and doctors revived her after performing CPR for about two hours. She was placed on a life support system to restore oxygen to her blood. Doctors also put her on a machine to do the work of her heart while waiting for a transplant. The infection morphed into a serious case of myocarditis. The patient died from flu complications at 10:45 AM on 05 April 2013. Outcome was fatal. Documents held by sender: none.


Changed on 12/14/2016

VAERS ID: 489391 Before After
VAERS Form:
Age:10.0
Sex:Female
Location:Tennessee
Vaccinated:2012-12-01
Onset:2013-03-20
Submitted:2013-04-15
Entered:2013-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Cardiac arrest, Chest pain, Death, Dyspnoea, Influenza, Life support, Myocarditis, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201304714

Write-up: Initial report was received on 08 April 2013 from an electronic lay press article. A 10-year-old female patient had received an injection of INFLUENZA VACCINE (trade name, manufacturer, lot number, route, site and exact date of administration not reported) in December 2012. The patient was diagnosed with strain B flu on 20 March 2013. Three days after the patient was diagnosed with the flu, she was rushed to the hospital after complaining of stomach and chest pains and difficulty breathing. She went into cardiac arrest the following morning, and doctors revived her after performing CPR for about two hours. She was placed on a life support system to restore oxygen to her blood. Doctors also put her on a machine to do the work of her heart while waiting for a transplant. The infection morphed into a serious case of myocarditis. The patient died from flu complications at 10:45 AM on 05 April 2013. Outcome was fatal. Documents held by sender: none.


Changed on 9/14/2017

VAERS ID: 489391 Before After
VAERS Form:(blank) 1
Age:10.0
Sex:Female
Location:Tennessee
Vaccinated:2012-12-01
Onset:2013-03-20
Submitted:2013-04-15
Entered:2013-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Cardiac arrest, Chest pain, Death, Dyspnoea, Influenza, Life support, Myocarditis, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201304714

Write-up: Initial report was received on 08 April 2013 from an electronic lay press article. A 10-year-old female patient had received an injection of INFLUENZA VACCINE (trade name, manufacturer, lot number, route, site and exact date of administration not reported) in December 2012. The patient was diagnosed with strain B flu on 20 March 2013. Three days after the patient was diagnosed with the flu, she was rushed to the hospital after complaining of stomach and chest pains and difficulty breathing. She went into cardiac arrest the following morning, and doctors revived her after performing CPR for about two hours. She was placed on a life support system to restore oxygen to her blood. Doctors also put her on a machine to do the work of her heart while waiting for a transplant. The infection morphed into a serious case of myocarditis. The patient died from flu complications at 10:45 AM on 05 April 2013. Outcome was fatal. Documents held by sender: none.


Changed on 2/14/2018

VAERS ID: 489391 Before After
VAERS Form:1
Age:10.0
Sex:Female
Location:Tennessee
Vaccinated:2012-12-01
Onset:2013-03-20
Submitted:2013-04-15
Entered:2013-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Cardiac arrest, Chest pain, Death, Dyspnoea, Influenza, Life support, Myocarditis, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201304714

Write-up: Initial report was received on 08 April 2013 from an electronic lay press article. A 10-year-old female patient had received an injection of INFLUENZA VACCINE (trade name, manufacturer, lot number, route, site and exact date of administration not reported) in December 2012. The patient was diagnosed with strain B flu on 20 March 2013. Three days after the patient was diagnosed with the flu, she was rushed to the hospital after complaining of stomach and chest pains and difficulty breathing. She went into cardiac arrest the following morning, and doctors revived her after performing CPR for about two hours. She was placed on a life support system to restore oxygen to her blood. Doctors also put her on a machine to do the work of her heart while waiting for a transplant. The infection morphed into a serious case of myocarditis. The patient died from flu complications at 10:45 AM on 05 April 2013. Outcome was fatal. Documents held by sender: none.


Changed on 6/14/2018

VAERS ID: 489391 Before After
VAERS Form:1
Age:10.0
Sex:Female
Location:Tennessee
Vaccinated:2012-12-01
Onset:2013-03-20
Submitted:2013-04-15
Entered:2013-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Cardiac arrest, Chest pain, Death, Dyspnoea, Influenza, Life support, Myocarditis, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201304714

Write-up: Initial report was received on 08 April 2013 from an electronic lay press article. A 10-year-old female patient had received an injection of INFLUENZA VACCINE (trade name, manufacturer, lot number, route, site and exact date of administration not reported) in December 2012. The patient was diagnosed with strain B flu on 20 March 2013. Three days after the patient was diagnosed with the flu, she was rushed to the hospital after complaining of stomach and chest pains and difficulty breathing. She went into cardiac arrest the following morning, and doctors revived her after performing CPR for about two hours. She was placed on a life support system to restore oxygen to her blood. Doctors also put her on a machine to do the work of her heart while waiting for a transplant. The infection morphed into a serious case of myocarditis. The patient died from flu complications at 10:45 AM on 05 April 2013. Outcome was fatal. Documents held by sender: none.


Changed on 8/14/2018

VAERS ID: 489391 Before After
VAERS Form:1
Age:10.0
Sex:Female
Location:Tennessee
Vaccinated:2012-12-01
Onset:2013-03-20
Submitted:2013-04-15
Entered:2013-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Cardiac arrest, Chest pain, Death, Dyspnoea, Influenza, Life support, Myocarditis, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201304714

Write-up: Initial report was received on 08 April 2013 from an electronic lay press article. A 10-year-old female patient had received an injection of INFLUENZA VACCINE (trade name, manufacturer, lot number, route, site and exact date of administration not reported) in December 2012. The patient was diagnosed with strain B flu on 20 March 2013. Three days after the patient was diagnosed with the flu, she was rushed to the hospital after complaining of stomach and chest pains and difficulty breathing. She went into cardiac arrest the following morning, and doctors revived her after performing CPR for about two hours. She was placed on a life support system to restore oxygen to her blood. Doctors also put her on a machine to do the work of her heart while waiting for a transplant. The infection morphed into a serious case of myocarditis. The patient died from flu complications at 10:45 AM on 05 April 2013. Outcome was fatal. Documents held by sender: none.


Changed on 9/14/2018

VAERS ID: 489391 Before After
VAERS Form:1
Age:10.0
Sex:Female
Location:Tennessee
Vaccinated:2012-12-01
Onset:2013-03-20
Submitted:2013-04-15
Entered:2013-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Cardiac arrest, Chest pain, Death, Dyspnoea, Influenza, Life support, Myocarditis, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201304714

Write-up: Initial report was received on 08 April 2013 from an electronic lay press article. A 10-year-old female patient had received an injection of INFLUENZA VACCINE (trade name, manufacturer, lot number, route, site and exact date of administration not reported) in December 2012. The patient was diagnosed with strain B flu on 20 March 2013. Three days after the patient was diagnosed with the flu, she was rushed to the hospital after complaining of stomach and chest pains and difficulty breathing. She went into cardiac arrest the following morning, and doctors revived her after performing CPR for about two hours. She was placed on a life support system to restore oxygen to her blood. Doctors also put her on a machine to do the work of her heart while waiting for a transplant. The infection morphed into a serious case of myocarditis. The patient died from flu complications at 10:45 AM on 05 April 2013. Outcome was fatal. Documents held by sender: none.


Changed on 10/14/2018

VAERS ID: 489391 Before After
VAERS Form:1
Age:10.0
Sex:Female
Location:Tennessee
Vaccinated:2012-12-01
Onset:2013-03-20
Submitted:2013-04-15
Entered:2013-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / SYR

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Cardiac arrest, Chest pain, Death, Dyspnoea, Influenza, Life support, Myocarditis, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-05
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Not reported
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201304714

Write-up: Initial report was received on 08 April 2013 from an electronic lay press article. A 10-year-old female patient had received an injection of INFLUENZA VACCINE (trade name, manufacturer, lot number, route, site and exact date of administration not reported) in December 2012. The patient was diagnosed with strain B flu on 20 March 2013. Three days after the patient was diagnosed with the flu, she was rushed to the hospital after complaining of stomach and chest pains and difficulty breathing. She went into cardiac arrest the following morning, and doctors revived her after performing CPR for about two hours. She was placed on a life support system to restore oxygen to her blood. Doctors also put her on a machine to do the work of her heart while waiting for a transplant. The infection morphed into a serious case of myocarditis. The patient died from flu complications at 10:45 AM on 05 April 2013. Outcome was fatal. Documents held by sender: none.

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