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This is VAERS ID 58135

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58135
VAERS Form:
Age:73.0
Sex:Male
Location:Massachusetts
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1993-12-07
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1993-1994 / PARKE-DAVIS - / 3 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, PNEUMONIA, HEM LUNG, EFFUS PERICARD, MARROW HYPERPLASIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;


Changed on 12/8/2009

VAERS ID: 58135 Before After
VAERS Form:
Age:73.0
Sex:Male
Location:Massachusetts
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1993-12-07
Entered:1993-12-20 1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1993-1994 INFLUENZA (SEASONAL) (FLUOGEN 93-94) / PARKE-DAVIS - / 3 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Infection, Marrow hyperplasia, Pericardial effusion, Pneumonia, Pulmonary haemorrhage, Respiratory disorder, Thrombocytopenia, Thrombocytopenic purpura, INFECT, PNEUMONIA, HEM LUNG, EFFUS PERICARD, MARROW HYPERPLASIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CO5163

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;


Changed on 8/31/2010

VAERS ID: 58135 Before After
VAERS Form:
Age:73.0
Sex:Male
Location:Massachusetts
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 93-94) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Infection, Marrow hyperplasia, Pericardial effusion, Pneumonia, Pulmonary haemorrhage, Respiratory disorder, Thrombocytopenia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5163

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;


Changed on 7/7/2013

VAERS ID: 58135 Before After
VAERS Form:
Age:73.0
Sex:Male
Location:Massachusetts
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 3 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Infection, Marrow hyperplasia, Pericardial effusion, Pneumonia, Pulmonary haemorrhage, Respiratory disorder, Thrombocytopenia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5163

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;


Changed on 5/14/2017

VAERS ID: 58135 Before After
VAERS Form:
Age:73.0
Sex:Male
Location:Massachusetts
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 3 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Infection, Marrow hyperplasia, Pericardial effusion, Pneumonia, Pulmonary haemorrhage, Respiratory disorder, Thrombocytopenia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5163

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;


Changed on 9/14/2017

VAERS ID: 58135 Before After
VAERS Form:(blank) 1
Age:73.0
Sex:Male
Location:Massachusetts
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 3 4 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Infection, Marrow hyperplasia, Pericardial effusion, Pneumonia, Pulmonary haemorrhage, Respiratory disorder, Thrombocytopenia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5163

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;


Changed on 2/14/2018

VAERS ID: 58135 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Massachusetts
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 4 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Infection, Marrow hyperplasia, Pericardial effusion, Pneumonia, Pulmonary haemorrhage, Respiratory disorder, Thrombocytopenia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5163

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;


Changed on 6/14/2018

VAERS ID: 58135 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Massachusetts
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 4 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Infection, Marrow hyperplasia, Pericardial effusion, Pneumonia, Pulmonary haemorrhage, Respiratory disorder, Thrombocytopenia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5163

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;


Changed on 8/14/2018

VAERS ID: 58135 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Massachusetts
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 4 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Infection, Marrow hyperplasia, Pericardial effusion, Pneumonia, Pulmonary haemorrhage, Respiratory disorder, Thrombocytopenia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5163

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;


Changed on 9/14/2018

VAERS ID: 58135 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Massachusetts
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 4 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Infection, Marrow hyperplasia, Pericardial effusion, Pneumonia, Pulmonary haemorrhage, Respiratory disorder, Thrombocytopenia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5163

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;


Changed on 10/14/2018

VAERS ID: 58135 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Massachusetts
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 4 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Infection, Marrow hyperplasia, Pericardial effusion, Pneumonia, Pulmonary haemorrhage, Respiratory disorder, Thrombocytopenia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Nitrodur patch 0.2 mg, tenormin 25 mg daily, aspirin 25 mg every other day;
Current Illness: None
Preexisting Conditions: MI & CVA 1991
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5163

Write-up: died; devel thrombocytopenia 2 wks p/vax; No autopsy performed;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=58135&WAYBACKHISTORY=ON


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