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This is VAERS ID 56919

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 56919
VAERS Form:
Age:67.9
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938147 / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: STUPOR, CARDIOVASC DIS, HYPERTENS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


Changed on 12/8/2009

VAERS ID: 56919 Before After
VAERS Form:
Age:67.9
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-05 1993-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH WYETH PHARMACEUTICALS, INC 4938147 / 0 - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor, STUPOR, CARDIOVASC DIS, HYPERTENS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


Changed on 8/31/2010

VAERS ID: 56919 Before After
VAERS Form:
Age:67.9
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4938147 / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


Changed on 7/7/2013

VAERS ID: 56919 Before After
VAERS Form:
Age:67.9
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 0 - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


Changed on 12/14/2016

VAERS ID: 56919 Before After
VAERS Form:
Age:67.9
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 0 - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


Changed on 2/14/2017

VAERS ID: 56919 Before After
VAERS Form:
Age:67.9 67.0
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


Changed on 5/14/2017

VAERS ID: 56919 Before After
VAERS Form:
Age:67.0
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


Changed on 9/14/2017

VAERS ID: 56919 Before After
VAERS Form:(blank) 1
Age:67.0
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 0 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


Changed on 2/14/2018

VAERS ID: 56919 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


Changed on 6/14/2018

VAERS ID: 56919 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


Changed on 8/14/2018

VAERS ID: 56919 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


Changed on 9/14/2018

VAERS ID: 56919 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;


Changed on 10/14/2018

VAERS ID: 56919 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:North Carolina
Vaccinated:1993-09-29
Onset:1993-09-30
Submitted:1993-10-27
Entered:1993-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938147 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiovascular disorder, Hypertension, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-01
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: Prolixin;
Current Illness: PVC/head injury;
Preexisting Conditions: hx of ventricular arrhythmia; chronic dementia, diabetes, CHF;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29SEP93 1800 vax given; 30SPE93 0830 pt nonresponsive to any stimuli; 1OCT93 0300 pt expired; COD hypertensive cardiovascular disease;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=56919&WAYBACKHISTORY=ON


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