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This is VAERS ID 857584

History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2020

VAERS ID: 857584
VAERS Form:2
Age:60.0
Sex:Female
Location:California
Vaccinated:2020-01-01
Onset:2020-01-01
Submitted:0000-00-00
Entered:2020-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS QS 2019-20 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Life support, Pneumonia, Sepsis, General physical health deterioration, Organ failure, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-01-11
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen Albuterol Benzonatate Ipratropium-Albuterol Ketorolac Sodium Chloride Anti Depressant
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10 Days on life support with constant tests, no improvement, quick decline. Currently obtaining full records.
CDC 'Split Type':

Write-up: Given while ill with fever and flu. Quick deterioration. Lung and blood infection. Sepsis within 24 hours. Life support with organ failure. Death in one week time.


Changed on 12/24/2020

VAERS ID: 857584 Before After
VAERS Form:2
Age:60.0
Sex:Female
Location:California
Vaccinated:2020-01-01
Onset:2020-01-01
Submitted:0000-00-00
Entered:2020-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS QS 2019-20 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Life support, Pneumonia, Sepsis, General physical health deterioration, Organ failure, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-01-11
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen Albuterol Benzonatate Ipratropium-Albuterol Ketorolac Sodium Chloride Anti Depressant
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10 Days on life support with constant tests, no improvement, quick decline. Currently obtaining full records.
CDC 'Split Type':

Write-up: Given while ill with fever and flu. Quick deterioration. Lung and blood infection. Sepsis within 24 hours. Life support with organ failure. Death in one week time.


Changed on 12/30/2020

VAERS ID: 857584 Before After
VAERS Form:2
Age:60.0
Sex:Female
Location:California
Vaccinated:2020-01-01
Onset:2020-01-01
Submitted:0000-00-00
Entered:2020-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS QS 2019-20 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Life support, Pneumonia, Sepsis, General physical health deterioration, Organ failure, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-01-11
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen Albuterol Benzonatate Ipratropium-Albuterol Ketorolac Sodium Chloride Anti Depressant
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10 Days on life support with constant tests, no improvement, quick decline. Currently obtaining full records.
CDC 'Split Type':

Write-up: Given while ill with fever and flu. Quick deterioration. Lung and blood infection. Sepsis within 24 hours. Life support with organ failure. Death in one week time.


Changed on 5/7/2021

VAERS ID: 857584 Before After
VAERS Form:2
Age:60.0
Sex:Female
Location:California
Vaccinated:2020-01-01
Onset:2020-01-01
Submitted:0000-00-00
Entered:2020-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS QS 2019-20 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Life support, Pneumonia, Sepsis, General physical health deterioration, Organ failure, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-01-11
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen Albuterol Benzonatate Ipratropium-Albuterol Ketorolac Sodium Chloride Anti Depressant
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10 Days on life support with constant tests, no improvement, quick decline. Currently obtaining full records.
CDC 'Split Type':

Write-up: Given while ill with fever and flu. Quick deterioration. Lung and blood infection. Sepsis within 24 hours. Life support with organ failure. Death in one week time.


Changed on 5/14/2021

VAERS ID: 857584 Before After
VAERS Form:2
Age:60.0
Sex:Female
Location:California
Vaccinated:2020-01-01
Onset:2020-01-01
Submitted:0000-00-00
Entered:2020-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS QS 2019-20 / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Life support, Pneumonia, Sepsis, General physical health deterioration, Organ failure, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-01-11
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen Albuterol Benzonatate Ipratropium-Albuterol Ketorolac Sodium Chloride Anti Depressant
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10 Days on life support with constant tests, no improvement, quick decline. Currently obtaining full records.
CDC 'Split Type':

Write-up: Given while ill with fever and flu. Quick deterioration. Lung and blood infection. Sepsis within 24 hours. Life support with organ failure. Death in one week time.

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