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This is VAERS ID 49057

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 49057
VAERS Form:
Age:68.3
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1992-1993 / WYETH - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: ARTHRALGIA, LEUKOCYTOSIS, COAGUL DIS, HEM, EFFUS PLEURAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type':

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


Changed on 12/8/2009

VAERS ID: 49057 Before After
VAERS Form:
Age:68.3
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-21 1993-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1992-1993 INFLUENZA (SEASONAL) (NO BRAND NAME, 92-93) / WYETH WYETH PHARMACEUTICALS, INC - / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion, Haemorrhage, ARTHRALGIA, LEUKOCYTOSIS, COAGUL DIS, HEM, EFFUS PLEURAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type': (blank) 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


Changed on 8/31/2010

VAERS ID: 49057 Before After
VAERS Form:
Age:68.3
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 92-93) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type': 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


Changed on 7/7/2013

VAERS ID: 49057 Before After
VAERS Form:
Age:68.3
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type': 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


Changed on 12/14/2016

VAERS ID: 49057 Before After
VAERS Form:
Age:68.3
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type': 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


Changed on 2/14/2017

VAERS ID: 49057 Before After
VAERS Form:
Age:68.3 68.0
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type': 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


Changed on 5/14/2017

VAERS ID: 49057 Before After
VAERS Form:
Age:68.0
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type': 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


Changed on 9/14/2017

VAERS ID: 49057 Before After
VAERS Form:(blank) 1
Age:68.0
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type': 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


Changed on 2/14/2018

VAERS ID: 49057 Before After
VAERS Form:1
Age:68.0
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type': 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


Changed on 6/14/2018

VAERS ID: 49057 Before After
VAERS Form:1
Age:68.0
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type': 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


Changed on 8/14/2018

VAERS ID: 49057 Before After
VAERS Form:1
Age:68.0
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type': 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


Changed on 9/14/2018

VAERS ID: 49057 Before After
VAERS Form:1
Age:68.0
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type': 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;


Changed on 10/14/2018

VAERS ID: 49057 Before After
VAERS Form:1
Age:68.0
Sex:Female
Location:California
Vaccinated:1992-10-21
Onset:1992-11-07
Submitted:1992-11-23
Entered:1993-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Coagulopathy, Condition aggravated, Leukocytosis, Pleural effusion, Sepsis, Vascular occlusion, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 26     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hypertension meds
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: cocci latex test was pos;
CDC 'Split Type': 892343002K

Write-up: pt recvd flu vax & 1 mo later, devel rash, cough, pleuritic chest pain & an inflitrate was seen on cxr; found to have vasculitis; tx w/steroids; pt died; autopsy is pending;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=49057&WAYBACKHISTORY=ON


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