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This is VAERS ID 58871

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58871
VAERS Form:
Age:68.6
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938088 / - - / -
PPV: PNU-IMUNE(R)23 / LEDERLE 324906 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: APNEA, PNEUMONIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 12/8/2009

VAERS ID: 58871 Before After
VAERS Form:
Age:68.6
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-11 1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH WYETH PHARMACEUTICALS, INC 4938088 / - - / -
PPV: PNU-IMUNE(R)23 PNEUMO (PNU-IMUNE) / LEDERLE LEDERLE LABORATORIES 324906 / - - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Apnoea, Pneumonia, APNEA, PNEUMONIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 8/31/2010

VAERS ID: 58871 Before After
VAERS Form:
Age:68.6
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4938088 / - - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 324906 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 7/7/2013

VAERS ID: 58871 Before After
VAERS Form:
Age:68.6
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / - - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 324906 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 12/14/2016

VAERS ID: 58871 Before After
VAERS Form:
Age:68.6
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / - - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 324906 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 2/14/2017

VAERS ID: 58871 Before After
VAERS Form:
Age:68.6 68.0
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / - - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 324906 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 5/14/2017

VAERS ID: 58871 Before After
VAERS Form:
Age:68.0
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / - - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 324906 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 9/14/2017

VAERS ID: 58871 Before After
VAERS Form:(blank) 1
Age:68.0
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / - UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 324906 / - UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 2/14/2018

VAERS ID: 58871 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 324906 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 6/14/2018

VAERS ID: 58871 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 324906 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 8/14/2018

VAERS ID: 58871 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 324906 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 9/14/2018

VAERS ID: 58871 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 324906 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 10/14/2018

VAERS ID: 58871 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 324906 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 12/24/2020

VAERS ID: 58871 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 324906 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;


Changed on 12/30/2020

VAERS ID: 58871 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Florida
Vaccinated:1993-09-28
Onset:1993-12-18
Submitted:1994-01-03
Entered:1994-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938088 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 324906 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-12-18
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: Lasix, Potassium, Lomadin, Lanoxin;
Current Illness: heart failure;
Preexisting Conditions: hx CAD
Allergies:
Diagnostic Lab Data: Lung biopsy;
CDC 'Split Type':

Write-up: respiratory failure, usual interstital pneumonia, death;

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