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This is VAERS ID 844189

History of Changes from the VAERS Wayback Machine

First Appeared on 11/14/2019

VAERS ID: 844189
VAERS Form:2
Age:75.0
Sex:Male
Location:Arkansas
Vaccinated:2019-10-29
Onset:2019-10-29
Submitted:0000-00-00
Entered:2019-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ288AB / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Aspiration, Cyanosis, Death, Pulse absent, Resuscitation, Syncope, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-10-29
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: Levemir, Pravastatin, Furosemide, Lisinopril, Latanoprost
Current Illness: Diabetes, COPD
Preexisting Conditions: Diabetes, COPD
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient Fainted when he got to his cart. Pharmacist rushed to his side. He was already blue, and pharmacist could not feel a pulse. Patient was moved quickly to start CPR. CPR was started and patient was aspirating. Mouth and nose were cleared out. CPR was continued. Patient was aspirating and breaths could not me administered. CPR was continued until EMT arrived. EMT continued CPR. Patient was not responsive. EMT called time of death.


Changed on 12/24/2020

VAERS ID: 844189 Before After
VAERS Form:2
Age:75.0
Sex:Male
Location:Arkansas
Vaccinated:2019-10-29
Onset:2019-10-29
Submitted:0000-00-00
Entered:2019-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ288AB / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Aspiration, Cyanosis, Death, Pulse absent, Resuscitation, Syncope, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-10-29
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: Levemir, Pravastatin, Furosemide, Lisinopril, Latanoprost
Current Illness: Diabetes, COPD
Preexisting Conditions: Diabetes, COPD
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient Fainted when he got to his cart. Pharmacist rushed to his side. He was already blue, and pharmacist could not feel a pulse. Patient was moved quickly to start CPR. CPR was started and patient was aspirating. Mouth and nose were cleared out. CPR was continued. Patient was aspirating and breaths could not me administered. CPR was continued until EMT arrived. EMT continued CPR. Patient was not responsive. EMT called time of death.


Changed on 12/30/2020

VAERS ID: 844189 Before After
VAERS Form:2
Age:75.0
Sex:Male
Location:Arkansas
Vaccinated:2019-10-29
Onset:2019-10-29
Submitted:0000-00-00
Entered:2019-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ288AB / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Aspiration, Cyanosis, Death, Pulse absent, Resuscitation, Syncope, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-10-29
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: Levemir, Pravastatin, Furosemide, Lisinopril, Latanoprost
Current Illness: Diabetes, COPD
Preexisting Conditions: Diabetes, COPD
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient Fainted when he got to his cart. Pharmacist rushed to his side. He was already blue, and pharmacist could not feel a pulse. Patient was moved quickly to start CPR. CPR was started and patient was aspirating. Mouth and nose were cleared out. CPR was continued. Patient was aspirating and breaths could not me administered. CPR was continued until EMT arrived. EMT continued CPR. Patient was not responsive. EMT called time of death.


Changed on 5/7/2021

VAERS ID: 844189 Before After
VAERS Form:2
Age:75.0
Sex:Male
Location:Arkansas
Vaccinated:2019-10-29
Onset:2019-10-29
Submitted:0000-00-00
Entered:2019-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ288AB / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Aspiration, Cyanosis, Death, Pulse absent, Resuscitation, Syncope, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-10-29
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: Levemir, Pravastatin, Furosemide, Lisinopril, Latanoprost
Current Illness: Diabetes, COPD
Preexisting Conditions: Diabetes, COPD
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient Fainted when he got to his cart. Pharmacist rushed to his side. He was already blue, and pharmacist could not feel a pulse. Patient was moved quickly to start CPR. CPR was started and patient was aspirating. Mouth and nose were cleared out. CPR was continued. Patient was aspirating and breaths could not me administered. CPR was continued until EMT arrived. EMT continued CPR. Patient was not responsive. EMT called time of death.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=844189&WAYBACKHISTORY=ON


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