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This is VAERS ID 57612

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 57612
VAERS Form:
Age:79.6
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938185 / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: FEVER, DYSPNEA, INFARCT MYOCARD

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


Changed on 12/8/2009

VAERS ID: 57612 Before After
VAERS Form:
Age:79.6
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-12-01 1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH WYETH PHARMACEUTICALS, INC 4938185 / 0 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia, FEVER, DYSPNEA, INFARCT MYOCARD

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


Changed on 8/31/2010

VAERS ID: 57612 Before After
VAERS Form:
Age:79.6
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4938185 / 0 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


Changed on 7/7/2013

VAERS ID: 57612 Before After
VAERS Form:
Age:79.6
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 0 - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 0 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


Changed on 12/14/2016

VAERS ID: 57612 Before After
VAERS Form:
Age:79.6
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 0 - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 0 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


Changed on 2/14/2017

VAERS ID: 57612 Before After
VAERS Form:
Age:79.6 79.0
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 0 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


Changed on 5/14/2017

VAERS ID: 57612 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 0 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


Changed on 9/14/2017

VAERS ID: 57612 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 0 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


Changed on 2/14/2018

VAERS ID: 57612 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


Changed on 6/14/2018

VAERS ID: 57612 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


Changed on 8/14/2018

VAERS ID: 57612 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


Changed on 9/14/2018

VAERS ID: 57612 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;


Changed on 10/14/2018

VAERS ID: 57612 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:New York
Vaccinated:1993-10-23
Onset:1993-10-23
Submitted:1993-11-10
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938185 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Myocardial infarction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-23
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: no other listed conditions ;
Preexisting Conditions: cardiac problems/ASHD/COPD/MI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given 23OCT92 during 7-3shift; 4Pm t99.4; 930PM temp 102; pt died 945 PM;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=57612&WAYBACKHISTORY=ON


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