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This is VAERS ID 56721

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 56721
VAERS Form:
Age:70.8
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938180 / - A / IM

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, NAUSEA, SYNCOPE, EMB PULM, THROMBOPHLEB DEEP

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


Changed on 12/8/2009

VAERS ID: 56721 Before After
VAERS Form:
Age:70.8
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-29 1993-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH WYETH PHARMACEUTICALS, INC 4938180 / - A / IM

Administered by: Public      Purchased by: Unknown Other
Symptoms: Nausea, Pulmonary embolism, Pyrexia, Syncope, Deep vein thrombosis, FEVER, NAUSEA, SYNCOPE, EMB PULM, THROMBOPHLEB DEEP

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


Changed on 8/31/2010

VAERS ID: 56721 Before After
VAERS Form:
Age:70.8
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4938180 / - A / IM

Administered by: Public      Purchased by: Other
Symptoms: Nausea, Pulmonary embolism, Pyrexia, Syncope, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


Changed on 7/7/2013

VAERS ID: 56721 Before After
VAERS Form:
Age:70.8
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / - A / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / - A / IM

Administered by: Public      Purchased by: Other
Symptoms: Nausea, Pulmonary embolism, Pyrexia, Syncope, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


Changed on 12/14/2016

VAERS ID: 56721 Before After
VAERS Form:
Age:70.8
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / - A / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / - A / IM

Administered by: Public      Purchased by: Other
Symptoms: Nausea, Pulmonary embolism, Pyrexia, Syncope, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


Changed on 2/14/2017

VAERS ID: 56721 Before After
VAERS Form:
Age:70.8 70.0
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / - A / IM

Administered by: Public      Purchased by: Other
Symptoms: Nausea, Pulmonary embolism, Pyrexia, Syncope, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


Changed on 5/14/2017

VAERS ID: 56721 Before After
VAERS Form:
Age:70.0
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / - A - / IM IM A

Administered by: Public      Purchased by: Other
Symptoms: Nausea, Pulmonary embolism, Pyrexia, Syncope, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


Changed on 9/14/2017

VAERS ID: 56721 Before After
VAERS Form:(blank) 1
Age:70.0
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / - UNK - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Nausea, Pulmonary embolism, Pyrexia, Syncope, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


Changed on 2/14/2018

VAERS ID: 56721 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / UNK - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Nausea, Pulmonary embolism, Pyrexia, Syncope, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


Changed on 6/14/2018

VAERS ID: 56721 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / UNK - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Nausea, Pulmonary embolism, Pyrexia, Syncope, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


Changed on 8/14/2018

VAERS ID: 56721 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / UNK - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Nausea, Pulmonary embolism, Pyrexia, Syncope, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


Changed on 9/14/2018

VAERS ID: 56721 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / UNK - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Nausea, Pulmonary embolism, Pyrexia, Syncope, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;


Changed on 10/14/2018

VAERS ID: 56721 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
Vaccinated:1993-10-09
Onset:1993-10-10
Submitted:1993-10-12
Entered:1993-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938180 / UNK - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Nausea, Pulmonary embolism, Pyrexia, Syncope, Deep vein thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-10
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: Dicloxacillin; APAP w/codeine, Prilosec, Mevacor, Tenormin, Zestril, Colchicine, Tagamet, Indocin, HCTZ, Reglan;
Current Illness:
Preexisting Conditions: Hypertension, diverticulitits, hiatal hernia, severe coronary artherosclerosis, nephrosclerosis, pituitary adenoma, obesity;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893285016J

Write-up: pt recvd flu vax 9OCT93 approx 24 hrs later pt devel fever & nausea; died in the ambulance on the way to the hosp;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=56721&WAYBACKHISTORY=ON


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