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This is VAERS ID 58410

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58410
VAERS Form:
Age:69.4
Sex:Male
Location:New York
Vaccinated:1993-12-14
Onset:1993-12-14
Submitted:1993-12-15
Entered:1993-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 / CONNAUGHT LABS 3F41123 / 0 A / -

Administered by: Private      Purchased by: Unknown
Symptoms: STUPOR, FLU SYND, PAIN CHEST, INFARCT MYOCARD

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-14
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:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


Changed on 12/8/2009

VAERS ID: 58410 Before After
VAERS Form:
Age:69.4
Sex:Male
Location:New York
Vaccinated:1993-12-14
Onset:1993-12-14
Submitted:1993-12-15
Entered:1993-12-29 1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 INFLUENZA (SEASONAL) (FLUZONE 93-94) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3F41123 / 0 A / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor, STUPOR, FLU SYND, PAIN CHEST, INFARCT MYOCARD

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-14
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:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


Changed on 8/31/2010

VAERS ID: 58410 Before After
VAERS Form:
Age:69.4
Sex:Male
Location:New York
Vaccinated:1993-12-14
Onset:1993-12-14
Submitted:1993-12-15
Entered:1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 93-94) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 0 A / -

Administered by: Private      Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-14
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:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


Changed on 7/7/2013

VAERS ID: 58410 Before After
VAERS Form:
Age:69.4
Sex:Male
Location:New York
Vaccinated:1993-12-14
Onset:1993-12-14
Submitted:1993-12-15
Entered:1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 0 A / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 0 A / -

Administered by: Private      Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-14
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:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


Changed on 2/14/2017

VAERS ID: 58410 Before After
VAERS Form:
Age:69.4 69.0
Sex:Male
Location:New York
Vaccinated:1993-12-14
Onset:1993-12-14
Submitted:1993-12-15
Entered:1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 0 A / -

Administered by: Private      Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-14
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:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


Changed on 5/14/2017

VAERS ID: 58410 Before After
VAERS Form:
Age:69.0
Sex:Male
Location:New York
Vaccinated:1993-12-14
Onset:1993-12-14
Submitted:1993-12-15
Entered:1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 0 A - / - A

Administered by: Private      Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-14
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:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


Changed on 9/14/2017

VAERS ID: 58410 Before After
VAERS Form:(blank) 1
Age:69.0
Sex:Male
Location:New York
Vaccinated:1993-12-14
Onset:1993-12-14
Submitted:1993-12-15
Entered:1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 0 1 - / A

Administered by: Private      Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-14
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:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


Changed on 2/14/2018

VAERS ID: 58410 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:New York
Vaccinated:1993-12-14
Onset:1993-12-14
Submitted:1993-12-15
Entered:1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 1 - / A

Administered by: Private      Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-14
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:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


Changed on 6/14/2018

VAERS ID: 58410 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:New York
Vaccinated:1993-12-14
Onset:1993-12-14
Submitted:1993-12-15
Entered:1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 1 - / A

Administered by: Private      Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-14
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:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


Changed on 8/14/2018

VAERS ID: 58410 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:New York
Vaccinated:1993-12-14
Onset:1993-12-14
Submitted:1993-12-15
Entered:1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 1 - / A

Administered by: Private      Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-14
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:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


Changed on 9/14/2018

VAERS ID: 58410 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:New York
Vaccinated:1993-12-14
Onset:1993-12-14
Submitted:1993-12-15
Entered:1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 1 - / A

Administered by: Private      Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-14
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:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93


Changed on 10/14/2018

VAERS ID: 58410 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:New York
Vaccinated:1993-12-14
Onset:1993-12-14
Submitted:1993-12-15
Entered:1993-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41123 / 1 - / A

Administered by: Private      Purchased by: Other
Symptoms: Chest pain, Influenza, Myocardial infarction, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-14
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:
Current Illness:
Preexisting Conditions: hx of 4 recent MI''s in past few yrs, obese 250 lbs, cardiac probs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt coded @ home 4Dec93 (MI) in evening. Expired 14Dec93

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