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This is VAERS ID 56603

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 56603
VAERS Form:
Age:85.1
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938120 / 0 A / IM

Administered by: Private      Purchased by: Unknown
Symptoms: HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


Changed on 12/8/2009

VAERS ID: 56603 Before After
VAERS Form:
Age:85.1
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-20 1993-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH WYETH PHARMACEUTICALS, INC 4938120 / 0 A / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Cardiac arrest, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


Changed on 8/31/2010

VAERS ID: 56603 Before After
VAERS Form:
Age:85.1
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4938120 / 0 A / IM

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


Changed on 7/7/2013

VAERS ID: 56603 Before After
VAERS Form:
Age:85.1
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 0 A / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 0 A / IM

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


Changed on 12/14/2016

VAERS ID: 56603 Before After
VAERS Form:
Age:85.1
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 0 A / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 0 A / IM

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


Changed on 2/14/2017

VAERS ID: 56603 Before After
VAERS Form:
Age:85.1 85.0
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 0 A / IM

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


Changed on 5/14/2017

VAERS ID: 56603 Before After
VAERS Form:
Age:85.0
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 0 A - / IM IM A

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: ~ ()~~~In patient
Other Medications: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


Changed on 9/14/2017

VAERS ID: 56603 Before After
VAERS Form:(blank) 1
Age:85.0
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 0 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: ~ ()~~~In patient
Other Medications: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


Changed on 2/14/2018

VAERS ID: 56603 Before After
VAERS Form:1
Age:85.0
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: ~ ()~~~In patient
Other Medications: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


Changed on 6/14/2018

VAERS ID: 56603 Before After
VAERS Form:1
Age:85.0
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: ~ ()~~~In patient
Other Medications: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


Changed on 8/14/2018

VAERS ID: 56603 Before After
VAERS Form:1
Age:85.0
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: ~ ()~~~In patient
Other Medications: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


Changed on 9/14/2018

VAERS ID: 56603 Before After
VAERS Form:1
Age:85.0
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: ~ ()~~~In patient
Other Medications: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;


Changed on 10/14/2018

VAERS ID: 56603 Before After
VAERS Form:1
Age:85.0
Sex:Female
Location:California
Vaccinated:1993-09-30
Onset:1993-09-30
Submitted:1993-10-01
Entered:1993-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938120 / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-09-30
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: ~ ()~~~In patient
Other Medications: Maxzide unspecified;
Current Illness: NONE
Preexisting Conditions: pt was elderly & described by MD as being in frail hlth; hx of hypertension; no hx of egg allergy;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893277002E

Write-up: Pt recvd vax & 20 mins later pt suffered a crdiac arrest & died; MD feels this event was unrelated to flu shield;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=56603&WAYBACKHISTORY=ON


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