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This is VAERS ID 786304

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2018

VAERS ID: 786304
VAERS Form:2
Age:71.0
Sex:Male
Location:North Dakota
Vaccinated:2018-11-07
Onset:2018-11-10
Submitted:0000-00-00
Entered:2018-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 252229 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-11-10
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: ASA, CARVEDILOL, FOLBEE, GLIPIZIDE ER
Current Illness: ANEMIA SECONDARY TO ABSORPTION ISSUES S/P GASTRIC BYPASS
Preexisting Conditions: TYPE 2 DIABETES; HYPERTENSION; HYPERLIPIDEMIA; KIDNEY STONES
Allergies: TRAMADOL
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: DIED AT HOME, UNATTENDED? 11-10-2018.


Changed on 12/24/2020

VAERS ID: 786304 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:North Dakota
Vaccinated:2018-11-07
Onset:2018-11-10
Submitted:0000-00-00
Entered:2018-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 252229 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-11-10
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: ASA, CARVEDILOL, FOLBEE, GLIPIZIDE ER
Current Illness: ANEMIA SECONDARY TO ABSORPTION ISSUES S/P GASTRIC BYPASS
Preexisting Conditions: TYPE 2 DIABETES; HYPERTENSION; HYPERLIPIDEMIA; KIDNEY STONES
Allergies: TRAMADOL TRAMADOL
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: DIED AT HOME, UNATTENDED? 11-10-2018.


Changed on 12/30/2020

VAERS ID: 786304 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:North Dakota
Vaccinated:2018-11-07
Onset:2018-11-10
Submitted:0000-00-00
Entered:2018-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 252229 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-11-10
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: ASA, CARVEDILOL, FOLBEE, GLIPIZIDE ER
Current Illness: ANEMIA SECONDARY TO ABSORPTION ISSUES S/P GASTRIC BYPASS
Preexisting Conditions: TYPE 2 DIABETES; HYPERTENSION; HYPERLIPIDEMIA; KIDNEY STONES
Allergies: TRAMADOL TRAMADOL
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: DIED AT HOME, UNATTENDED? 11-10-2018.

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