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This is VAERS ID 83553

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 83553
VAERS Form:
Age:82.9
Sex:Female
Location:Georgia
Vaccinated:1995-10-27
Onset:1995-10-29
Submitted:1995-11-01
Entered:1996-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 / WYETH 4958139 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-10-29
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: arhtritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: deceased 28OCT95


Changed on 12/8/2009

VAERS ID: 83553 Before After
VAERS Form:
Age:82.9
Sex:Female
Location:Georgia
Vaccinated:1995-10-27
Onset:1995-10-29
Submitted:1995-11-01
Entered:1996-03-13 1996-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 INFLUENZA (SEASONAL) (FLUSHIELD 95-96) / WYETH WYETH PHARMACEUTICALS, INC 4958139 / 2 RA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Apnoea, Cardiac arrest, Myocardial infarction, APNEA, HEART ARREST, INFARCT MYOCARD

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-10-29
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: arhtritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) GA96001

Write-up: deceased 28OCT95


Changed on 8/31/2010

VAERS ID: 83553 Before After
VAERS Form:
Age:82.9
Sex:Female
Location:Georgia
Vaccinated:1995-10-27
Onset:1995-10-29
Submitted:1995-11-01
Entered:1996-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 95-96) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4958139 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-10-29
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: arhtritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA96001

Write-up: deceased 28OCT95


Changed on 7/7/2013

VAERS ID: 83553 Before After
VAERS Form:
Age:82.9
Sex:Female
Location:Georgia
Vaccinated:1995-10-27
Onset:1995-10-29
Submitted:1995-11-01
Entered:1996-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958139 / 2 RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958139 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-10-29
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: arhtritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA96001

Write-up: deceased 28OCT95


Changed on 2/14/2017

VAERS ID: 83553 Before After
VAERS Form:
Age:82.9 82.0
Sex:Female
Location:Georgia
Vaccinated:1995-10-27
Onset:1995-10-29
Submitted:1995-11-01
Entered:1996-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958139 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-10-29
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: arhtritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA96001

Write-up: deceased 28OCT95


Changed on 5/14/2017

VAERS ID: 83553 Before After
VAERS Form:
Age:82.0
Sex:Female
Location:Georgia
Vaccinated:1995-10-27
Onset:1995-10-29
Submitted:1995-11-01
Entered:1996-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958139 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-10-29
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: arhtritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA96001

Write-up: deceased 28OCT95


Changed on 9/14/2017

VAERS ID: 83553 Before After
VAERS Form:(blank) 1
Age:82.0
Sex:Female
Location:Georgia
Vaccinated:1995-10-27
Onset:1995-10-29
Submitted:1995-11-01
Entered:1996-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958139 / 2 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-10-29
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: arhtritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA96001

Write-up: deceased 28OCT95


Changed on 2/14/2018

VAERS ID: 83553 Before After
VAERS Form:1
Age:82.0
Sex:Female
Location:Georgia
Vaccinated:1995-10-27
Onset:1995-10-29
Submitted:1995-11-01
Entered:1996-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958139 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-10-29
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: arhtritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA96001

Write-up: deceased 28OCT95


Changed on 6/14/2018

VAERS ID: 83553 Before After
VAERS Form:1
Age:82.0
Sex:Female
Location:Georgia
Vaccinated:1995-10-27
Onset:1995-10-29
Submitted:1995-11-01
Entered:1996-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958139 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-10-29
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: arhtritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA96001

Write-up: deceased 28OCT95


Changed on 8/14/2018

VAERS ID: 83553 Before After
VAERS Form:1
Age:82.0
Sex:Female
Location:Georgia
Vaccinated:1995-10-27
Onset:1995-10-29
Submitted:1995-11-01
Entered:1996-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958139 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-10-29
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: arhtritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA96001

Write-up: deceased 28OCT95


Changed on 9/14/2018

VAERS ID: 83553 Before After
VAERS Form:1
Age:82.0
Sex:Female
Location:Georgia
Vaccinated:1995-10-27
Onset:1995-10-29
Submitted:1995-11-01
Entered:1996-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958139 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-10-29
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: arhtritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA96001

Write-up: deceased 28OCT95


Changed on 10/14/2018

VAERS ID: 83553 Before After
VAERS Form:1
Age:82.0
Sex:Female
Location:Georgia
Vaccinated:1995-10-27
Onset:1995-10-29
Submitted:1995-11-01
Entered:1996-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958139 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-10-29
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: arhtritis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA96001

Write-up: deceased 28OCT95

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