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This is VAERS ID 56851

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 56851
VAERS Form:
Age:47.2
Sex:Male
Location:Maryland
Vaccinated:1993-10-28
Onset:1993-10-29
Submitted:1993-10-29
Entered:1993-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 / CONNAUGHT LABS 3F41035 / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: APNEA, HEART ARREST, DYSPEPSIA, CARDIOVASC DIS, ARTERIOSCLEROSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


Changed on 12/8/2009

VAERS ID: 56851 Before After
VAERS Form:
Age:47.2
Sex:Male
Location:Maryland
Vaccinated:1993-10-28
Onset:1993-10-29
Submitted:1993-10-29
Entered:1993-11-03 1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 INFLUENZA (SEASONAL) (FLUZONE 93-94) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3F41035 / - LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting, APNEA, HEART ARREST, DYSPEPSIA, CARDIOVASC DIS, ARTERIOSCLEROSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


Changed on 8/31/2010

VAERS ID: 56851 Before After
VAERS Form:
Age:47.2
Sex:Male
Location:Maryland
Vaccinated:1993-10-28
Onset:1993-10-29
Submitted:1993-10-29
Entered:1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 93-94) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


Changed on 7/7/2013

VAERS ID: 56851 Before After
VAERS Form:
Age:47.2
Sex:Male
Location:Maryland
Vaccinated:1993-10-28
Onset:1993-10-29
Submitted:1993-10-29
Entered:1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


Changed on 2/14/2017

VAERS ID: 56851 Before After
VAERS Form:
Age:47.2 47.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-28
Onset:1993-10-29
Submitted:1993-10-29
Entered:1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


Changed on 5/14/2017

VAERS ID: 56851 Before After
VAERS Form:
Age:47.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-28
Onset:1993-10-29
Submitted:1993-10-29
Entered:1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


Changed on 9/14/2017

VAERS ID: 56851 Before After
VAERS Form:(blank) 1
Age:47.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-28
Onset:1993-10-29
Submitted:1993-10-29
Entered:1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / - UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


Changed on 2/14/2018

VAERS ID: 56851 Before After
VAERS Form:1
Age:47.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-28
Onset:1993-10-29
Submitted:1993-10-29
Entered:1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


Changed on 6/14/2018

VAERS ID: 56851 Before After
VAERS Form:1
Age:47.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-28
Onset:1993-10-29
Submitted:1993-10-29
Entered:1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


Changed on 8/14/2018

VAERS ID: 56851 Before After
VAERS Form:1
Age:47.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-28
Onset:1993-10-29
Submitted:1993-10-29
Entered:1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


Changed on 9/14/2018

VAERS ID: 56851 Before After
VAERS Form:1
Age:47.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-28
Onset:1993-10-29
Submitted:1993-10-29
Entered:1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack


Changed on 10/14/2018

VAERS ID: 56851 Before After
VAERS Form:1
Age:47.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-28
Onset:1993-10-29
Submitted:1993-10-29
Entered:1993-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41035 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Arteriosclerosis, Cardiac arrest, Cardiovascular disorder, Dyspepsia, Injury, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD93041

Write-up: roommate called victim''s job to say that had become ill @ 230 AM & died @ home; CPR recvd; c/o indigestion, vomited 3-4 times over 20 min period; fell & hit chin on toilet bowl, turned blue, eyes glazed over, breathing stopped; heart attack

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=56851&WAYBACKHISTORY=ON


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