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This is VAERS ID 853847

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2020

VAERS ID: 853847
VAERS Form:2
Age:73.0
Sex:Male
Location:Unknown
Vaccinated:2019-12-15
Onset:2019-12-15
Submitted:0000-00-00
Entered:2019-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ308AB / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-12-15
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: history of stroke
Preexisting Conditions:
Allergies: No
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died within hours of receiving fluzone hd.


Changed on 12/10/2020

VAERS ID: 853847 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Unknown Illinois
Vaccinated:2019-12-15
Onset:2019-12-15
Submitted:0000-00-00
Entered:2019-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ308AB / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-12-15
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: history of stroke
Preexisting Conditions:
Allergies: No
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died within hours of receiving fluzone hd.


Changed on 12/24/2020

VAERS ID: 853847 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Illinois
Vaccinated:2019-12-15
Onset:2019-12-15
Submitted:0000-00-00
Entered:2019-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ308AB / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-12-15
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: history of stroke
Preexisting Conditions:
Allergies: No No
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died within hours of receiving fluzone hd.


Changed on 12/30/2020

VAERS ID: 853847 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Illinois
Vaccinated:2019-12-15
Onset:2019-12-15
Submitted:0000-00-00
Entered:2019-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ308AB / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-12-15
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: history of stroke
Preexisting Conditions:
Allergies: No No
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died within hours of receiving fluzone hd.


Changed on 5/7/2021

VAERS ID: 853847 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Illinois
Vaccinated:2019-12-15
Onset:2019-12-15
Submitted:0000-00-00
Entered:2019-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ308AB / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-12-15
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: history of stroke
Preexisting Conditions:
Allergies: No No
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died within hours of receiving fluzone hd.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=853847&WAYBACKHISTORY=ON


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