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This is VAERS ID 58157

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58157
VAERS Form:
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-10-15
Onset:1993-10-23
Submitted:1993-11-29
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938086 / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: APNEA, HEART ARREST

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: UNK
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': hypertension, sz disorder

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


Changed on 12/8/2009

VAERS ID: 58157 Before After
VAERS Form:
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-10-15
Onset:1993-10-23
Submitted:1993-11-29
Entered:1993-12-20 1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH WYETH PHARMACEUTICALS, INC 4938086 / - LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Apnoea, Cardiac arrest, APNEA, HEART ARREST

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: UNK
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': hypertension, sz disorder IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


Changed on 8/31/2010

VAERS ID: 58157 Before After
VAERS Form:
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-10-15
Onset:1993-10-23
Submitted:1993-11-29
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4938086 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

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: UNK
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


Changed on 7/7/2013

VAERS ID: 58157 Before After
VAERS Form:
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-10-15
Onset:1993-10-23
Submitted:1993-11-29
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

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: UNK
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


Changed on 12/14/2016

VAERS ID: 58157 Before After
VAERS Form:
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-10-15
Onset:1993-10-23
Submitted:1993-11-29
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / - LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

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: UNK
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


Changed on 5/14/2017

VAERS ID: 58157 Before After
VAERS Form:
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-10-15
Onset:1993-10-23
Submitted:1993-11-29
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

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: UNK UNK~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


Changed on 9/14/2017

VAERS ID: 58157 Before After
VAERS Form:(blank) 1
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-10-15
Onset:1993-10-23
Submitted:1993-11-29
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / - UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

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: UNK~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


Changed on 2/14/2018

VAERS ID: 58157 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-10-15
Onset:1993-10-23
Submitted:1993-11-29
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

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: UNK~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


Changed on 6/14/2018

VAERS ID: 58157 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-10-15
Onset:1993-10-23
Submitted:1993-11-29
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

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: UNK~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


Changed on 8/14/2018

VAERS ID: 58157 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-10-15
Onset:1993-10-23
Submitted:1993-11-29
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

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: UNK~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


Changed on 9/14/2018

VAERS ID: 58157 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-10-15
Onset:1993-10-23
Submitted:1993-11-29
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

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: UNK~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;


Changed on 10/14/2018

VAERS ID: 58157 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-10-15
Onset:1993-10-23
Submitted:1993-11-29
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938086 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

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: UNK~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: hypertension, sz disorder
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': IL93121

Write-up: death noticed in wkly newspaper-obituary had hx of hospitalization due to sz;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=58157&WAYBACKHISTORY=ON


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