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This is VAERS ID 854824

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2020

VAERS ID: 854824
VAERS Form:2
Age:66.0
Sex:Male
Location:Unknown
Vaccinated:2019-10-16
Onset:2019-12-11
Submitted:0000-00-00
Entered:2019-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION - / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Gait inability, Muscular weakness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12/6/19 - Presented to Emergency Rm with acute lower extremity weakness 12/7/19 Presented to ER cannot walk. Sent to Hospital 12/30/19 Expired


Changed on 12/10/2020

VAERS ID: 854824 Before After
VAERS Form:2
Age:66.0
Sex:Male
Location:Unknown New York
Vaccinated:2019-10-16
Onset:2019-12-11
Submitted:0000-00-00
Entered:2019-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION - / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Gait inability, Muscular weakness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12/6/19 - Presented to Emergency Rm with acute lower extremity weakness 12/7/19 Presented to ER cannot walk. Sent to Hospital 12/30/19 Expired


Changed on 12/24/2020

VAERS ID: 854824 Before After
VAERS Form:2
Age:66.0
Sex:Male
Location:New York
Vaccinated:2019-10-16
Onset:2019-12-11
Submitted:0000-00-00
Entered:2019-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION - / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Gait inability, Muscular weakness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12/6/19 - Presented to Emergency Rm with acute lower extremity weakness 12/7/19 Presented to ER cannot walk. Sent to Hospital 12/30/19 Expired


Changed on 12/30/2020

VAERS ID: 854824 Before After
VAERS Form:2
Age:66.0
Sex:Male
Location:New York
Vaccinated:2019-10-16
Onset:2019-12-11
Submitted:0000-00-00
Entered:2019-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION - / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Gait inability, Muscular weakness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12/6/19 - Presented to Emergency Rm with acute lower extremity weakness 12/7/19 Presented to ER cannot walk. Sent to Hospital 12/30/19 Expired

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=854824&WAYBACKHISTORY=ON


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