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This is VAERS ID 58884

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58884
VAERS Form:
Age:78.7
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 / CONNAUGHT LABS 3F41124 / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: BRADYCARDIA, ALLERG REACT, LDH INC, ALBUMINURIA, HYPOPROTEINEM

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Nephrotic synd, fever, minimally responsive state;


Changed on 12/8/2009

VAERS ID: 58884 Before After
VAERS Form:
Age:78.7 78.0
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-12 1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 INFLUENZA (SEASONAL) (FLUZONE 93-94) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3F41124 / - - / -

Administered by: Other Unknown      Purchased by: Unknown
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock, BRADYCARDIA, ALLERG REACT, LDH INC, ALBUMINURIA, HYPOPROTEINEM

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


Changed on 8/31/2010

VAERS ID: 58884 Before After
VAERS Form:
Age:78.0
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 93-94) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


Changed on 7/7/2013

VAERS ID: 58884 Before After
VAERS Form:
Age:78.0
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


Changed on 5/14/2017

VAERS ID: 58884 Before After
VAERS Form:
Age:78.0
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / - - / -

Administered by: Unknown Other      Purchased by: Unknown Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


Changed on 9/14/2017

VAERS ID: 58884 Before After
VAERS Form:(blank) 1
Age:78.0
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / - UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


Changed on 2/14/2018

VAERS ID: 58884 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


Changed on 6/14/2018

VAERS ID: 58884 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


Changed on 8/14/2018

VAERS ID: 58884 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


Changed on 9/14/2018

VAERS ID: 58884 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


Changed on 10/14/2018

VAERS ID: 58884 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


Changed on 12/24/2020

VAERS ID: 58884 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;


Changed on 12/30/2020

VAERS ID: 58884 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:Pennsylvania
Vaccinated:1993-10-14
Onset:1993-10-28
Submitted:1993-12-29
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Albuminuria, Blood lactate dehydrogenase increased, Bradycardia, Hypoproteinaemia, Nephrotic syndrome, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: anticoagulant therapy;
Current Illness:
Preexisting Conditions: DVT dx''d on 11MAY;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5214

Write-up: Nephrotic synd, fever, minimally responsive state;

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