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This is VAERS ID 58089

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58089
VAERS Form:
Age:65.7
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
Entered:1993-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938188 / 0 LA / -

Administered by: Public      Purchased by: Unknown
Symptoms: ASTHENIA, DIARRHEA, DYSPHAGIA, INFARCT MYOCARD, ARTERIOSCLEROSIS

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? No
Previous Vaccinations:
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


Changed on 12/8/2009

VAERS ID: 58089 Before After
VAERS Form:
Age:65.7
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
Entered:1993-12-16 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 4938188 / 0 LA / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis, ASTHENIA, DIARRHEA, DYSPHAGIA, INFARCT MYOCARD, ARTERIOSCLEROSIS

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? No
Previous Vaccinations:
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


Changed on 8/31/2010

VAERS ID: 58089 Before After
VAERS Form:
Age:65.7
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
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 4938188 / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis

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? No
Previous Vaccinations:
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


Changed on 7/7/2013

VAERS ID: 58089 Before After
VAERS Form:
Age:65.7
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 0 LA / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis

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? No
Previous Vaccinations:
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


Changed on 12/14/2016

VAERS ID: 58089 Before After
VAERS Form:
Age:65.7
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 0 LA / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis

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? No
Previous Vaccinations:
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


Changed on 2/14/2017

VAERS ID: 58089 Before After
VAERS Form:
Age:65.7 65.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis

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? No
Previous Vaccinations:
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


Changed on 5/14/2017

VAERS ID: 58089 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 0 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


Changed on 9/14/2017

VAERS ID: 58089 Before After
VAERS Form:(blank) 1
Age:65.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 0 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


Changed on 2/14/2018

VAERS ID: 58089 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


Changed on 6/14/2018

VAERS ID: 58089 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


Changed on 8/14/2018

VAERS ID: 58089 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


Changed on 9/14/2018

VAERS ID: 58089 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;


Changed on 10/14/2018

VAERS ID: 58089 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-10-25
Onset:1993-11-06
Submitted:1993-11-12
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938188 / 1 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Arteriosclerosis, Asthenia, Diarrhoea, Dysphagia, Infection, Myocardial infarction, Pharyngitis, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: vertigo-inner ear problem; bloodpressure rx;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': PA93171

Write-up: pt exp cold like sx, had trouble swallowing; 7NOV devel stomach virus, explosive diarrhea; stomach rolled 8NOV; felt very tired, wanted to rest, lost of mucus; dx-MI, severe hardening of arteries, hypertension;

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