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This is VAERS ID 58095

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58095
VAERS Form:
Age:79.7
Sex:Female
Location:South Carolina
Vaccinated:1993-11-02
Onset:1993-11-03
Submitted:1993-11-24
Entered:1993-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 / CONNAUGHT LABS 3F41007 / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: INFECT, MALAISE, PNEUMONIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-15
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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type':

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


Changed on 12/8/2009

VAERS ID: 58095 Before After
VAERS Form:
Age:79.7
Sex:Female
Location:South Carolina
Vaccinated:1993-11-02
Onset:1993-11-03
Submitted:1993-11-24
Entered:1993-12-16 1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 INFLUENZA (SEASONAL) (FLUZONE 93-94) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3F41007 / - LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Infection, Malaise, Pneumonia, INFECT, MALAISE, PNEUMONIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-15
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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': (blank) SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


Changed on 8/31/2010

VAERS ID: 58095 Before After
VAERS Form:
Age:79.7
Sex:Female
Location:South Carolina
Vaccinated:1993-11-02
Onset:1993-11-03
Submitted:1993-11-24
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 93-94) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-15
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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


Changed on 7/7/2013

VAERS ID: 58095 Before After
VAERS Form:
Age:79.7
Sex:Female
Location:South Carolina
Vaccinated:1993-11-02
Onset:1993-11-03
Submitted:1993-11-24
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-15
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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


Changed on 2/14/2017

VAERS ID: 58095 Before After
VAERS Form:
Age:79.7 79.0
Sex:Female
Location:South Carolina
Vaccinated:1993-11-02
Onset:1993-11-03
Submitted:1993-11-24
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-15
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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


Changed on 5/14/2017

VAERS ID: 58095 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:South Carolina
Vaccinated:1993-11-02
Onset:1993-11-03
Submitted:1993-11-24
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-15
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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


Changed on 9/14/2017

VAERS ID: 58095 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Female
Location:South Carolina
Vaccinated:1993-11-02
Onset:1993-11-03
Submitted:1993-11-24
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / - UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-15
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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


Changed on 2/14/2018

VAERS ID: 58095 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:South Carolina
Vaccinated:1993-11-02
Onset:1993-11-03
Submitted:1993-11-24
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-15
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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


Changed on 6/14/2018

VAERS ID: 58095 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:South Carolina
Vaccinated:1993-11-02
Onset:1993-11-03
Submitted:1993-11-24
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-15
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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


Changed on 8/14/2018

VAERS ID: 58095 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:South Carolina
Vaccinated:1993-11-02
Onset:1993-11-03
Submitted:1993-11-24
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-15
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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


Changed on 9/14/2018

VAERS ID: 58095 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:South Carolina
Vaccinated:1993-11-02
Onset:1993-11-03
Submitted:1993-11-24
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-15
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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;


Changed on 10/14/2018

VAERS ID: 58095 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:South Carolina
Vaccinated:1993-11-02
Onset:1993-11-03
Submitted:1993-11-24
Entered:1993-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41007 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Infection, Malaise, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-15
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: UNK
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC93143

Write-up: Pt recvd vax & felt badly; 8NOV felt worse; 9NOV seen by MD-CXR-clear; adm to hosp 15NOV93 died-dx strep pneumonia;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=58095&WAYBACKHISTORY=ON


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