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This is VAERS ID 58061

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58061
VAERS Form:
Age:68.5
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938143 / 2 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: HYPOTENS, APNEA, DYSPNEA, HEART ARREST, CARDIOMYOPATHY

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


Changed on 12/8/2009

VAERS ID: 58061 Before After
VAERS Form:
Age:68.5
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-15 1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH WYETH PHARMACEUTICALS, INC 4938143 / 2 - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute, HYPOTENS, APNEA, DYSPNEA, HEART ARREST, CARDIOMYOPATHY

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension; MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


Changed on 8/31/2010

VAERS ID: 58061 Before After
VAERS Form:
Age:68.5
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4938143 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


Changed on 7/7/2013

VAERS ID: 58061 Before After
VAERS Form:
Age:68.5
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 2 - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


Changed on 12/14/2016

VAERS ID: 58061 Before After
VAERS Form:
Age:68.5
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 2 - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


Changed on 2/14/2017

VAERS ID: 58061 Before After
VAERS Form:
Age:68.5 68.0
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


Changed on 5/14/2017

VAERS ID: 58061 Before After
VAERS Form:
Age:68.0
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK UNK~ ()~~~In patient
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


Changed on 9/14/2017

VAERS ID: 58061 Before After
VAERS Form:(blank) 1
Age:68.0
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 2 3 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


Changed on 2/14/2018

VAERS ID: 58061 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 3 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


Changed on 6/14/2018

VAERS ID: 58061 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 3 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


Changed on 8/14/2018

VAERS ID: 58061 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 3 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


Changed on 9/14/2018

VAERS ID: 58061 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 3 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;


Changed on 10/14/2018

VAERS ID: 58061 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:West Virginia
Vaccinated:1993-10-07
Onset:1993-10-12
Submitted:1993-11-16
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938143 / 3 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiomyopathy, Dyspnoea, Hypotension, Hypoxia, Pneumonia, Renal failure acute

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-08
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? Yes, days: 16     Extended hospital stay? Yes
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Feldene; Zyloprin; Normodyne; Calan SR;
Current Illness: NONE
Preexisting Conditions: No allergies noted Davocet allergy; old bilat cortial, infarcts, hypertension;
Allergies:
Diagnostic Lab Data: ejection fraction-227; echo dilated cardiomyopathy;
CDC 'Split Type': MD93052

Write-up: 5 days p/vax appetite loss, feeling poorly; 10 days p/vax URI, cough & SOB; given amoxicillin; x-ray: LLL infiltrate; MD rx for poss pneumonia; SOB, hypoxic; arrested in hosp; revived but...; dilated cardiomyopathy; cardopulmonary arrest;

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