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This is VAERS ID 57611

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 57611
VAERS Form:
Age:67.0
Sex:Male
Location:New York
Vaccinated:1993-10-07
Onset:1993-10-08
Submitted:1993-11-10
Entered:1993-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1993-1994 / PARKE-DAVIS 00573P / - - / IM
PPV: UNK. PNEUMOCOCCAL POLYVALENT / UNCLASSIFIED - / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: ARRHYTHMIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-08
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:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


Changed on 12/8/2009

VAERS ID: 57611 Before After
VAERS Form:
Age:67.0
Sex:Male
Location:New York
Vaccinated:1993-10-07
Onset:1993-10-08
Submitted:1993-11-10
Entered:1993-12-01 1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1993-1994 INFLUENZA (SEASONAL) (FLUOGEN 93-94) / PARKE-DAVIS 00573P / - - / IM
PPV: UNK. PNEUMOCOCCAL POLYVALENT PNEUMO (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / 0 - / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Arrhythmia, ARRHYTHMIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-08
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:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


Changed on 8/31/2010

VAERS ID: 57611 Before After
VAERS Form:
Age:67.0
Sex:Male
Location:New York
Vaccinated:1993-10-07
Onset:1993-10-08
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 93-94) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / - - / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Arrhythmia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-08
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:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


Changed on 7/7/2013

VAERS ID: 57611 Before After
VAERS Form:
Age:67.0
Sex:Male
Location:New York
Vaccinated:1993-10-07
Onset:1993-10-08
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / - - / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Arrhythmia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-08
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:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


Changed on 5/14/2017

VAERS ID: 57611 Before After
VAERS Form:
Age:67.0
Sex:Male
Location:New York
Vaccinated:1993-10-07
Onset:1993-10-08
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / - - / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Arrhythmia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-08
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:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


Changed on 9/14/2017

VAERS ID: 57611 Before After
VAERS Form:(blank) 1
Age:67.0
Sex:Male
Location:New York
Vaccinated:1993-10-07
Onset:1993-10-08
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / - UNK - / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Arrhythmia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-08
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:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


Changed on 2/14/2018

VAERS ID: 57611 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:New York
Vaccinated:1993-10-07
Onset:1993-10-08
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / UNK - / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Arrhythmia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-08
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:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


Changed on 6/14/2018

VAERS ID: 57611 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:New York
Vaccinated:1993-10-07
Onset:1993-10-08
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / UNK - / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Arrhythmia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-08
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:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


Changed on 8/14/2018

VAERS ID: 57611 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:New York
Vaccinated:1993-10-07
Onset:1993-10-08
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / UNK - / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Arrhythmia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-08
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:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


Changed on 9/14/2018

VAERS ID: 57611 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:New York
Vaccinated:1993-10-07
Onset:1993-10-08
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / UNK - / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Arrhythmia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-08
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:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;


Changed on 10/14/2018

VAERS ID: 57611 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:New York
Vaccinated:1993-10-07
Onset:1993-10-08
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00573P / UNK - / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Arrhythmia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-08
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:
Current Illness: only condition listed #19
Preexisting Conditions: hx of caridac problems/MI 11AUG93; was due for stress test surgery testing 8OCT93;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was found dead at home, no s/s or complaints, pt had existing condition of severe arrhythmia, severe cardiac conditions;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=57611&WAYBACKHISTORY=ON


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