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This is VAERS ID 860962

History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2020

VAERS ID: 860962
VAERS Form:2
Age:67.0
Sex:Male
Location:Arkansas
Vaccinated:2020-01-28
Onset:2020-02-04
Submitted:0000-00-00
Entered:2020-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ310AB / 1 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS 7RK7K / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac arrest, Death, Hypoxia, Influenza, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-04
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unlnown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client passed away on 2/4/2020 at 0832 AM. Cause of death states hypoxia, respiratory failure, cardiac arrest and influenza. Unknown if the vaccines were linked to death in anyway. Reported due to close timing the vaccines were administered to death.


Changed on 12/24/2020

VAERS ID: 860962 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Arkansas
Vaccinated:2020-01-28
Onset:2020-02-04
Submitted:0000-00-00
Entered:2020-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ310AB / 1 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS 7RK7K / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac arrest, Death, Hypoxia, Influenza, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-04
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unlnown Unlnown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client passed away on 2/4/2020 at 0832 AM. Cause of death states hypoxia, respiratory failure, cardiac arrest and influenza. Unknown if the vaccines were linked to death in anyway. Reported due to close timing the vaccines were administered to death.


Changed on 12/30/2020

VAERS ID: 860962 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Arkansas
Vaccinated:2020-01-28
Onset:2020-02-04
Submitted:0000-00-00
Entered:2020-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ310AB / 1 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS 7RK7K / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac arrest, Death, Hypoxia, Influenza, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-04
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unlnown Unlnown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client passed away on 2/4/2020 at 0832 AM. Cause of death states hypoxia, respiratory failure, cardiac arrest and influenza. Unknown if the vaccines were linked to death in anyway. Reported due to close timing the vaccines were administered to death.


Changed on 5/7/2021

VAERS ID: 860962 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Arkansas
Vaccinated:2020-01-28
Onset:2020-02-04
Submitted:0000-00-00
Entered:2020-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ310AB / 1 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS 7RK7K / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac arrest, Death, Hypoxia, Influenza, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-04
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unlnown Unlnown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client passed away on 2/4/2020 at 0832 AM. Cause of death states hypoxia, respiratory failure, cardiac arrest and influenza. Unknown if the vaccines were linked to death in anyway. Reported due to close timing the vaccines were administered to death.


Changed on 5/14/2021

VAERS ID: 860962 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Arkansas
Vaccinated:2020-01-28
Onset:2020-02-04
Submitted:0000-00-00
Entered:2020-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ310AB / 1 LA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS 7RK7K / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac arrest, Death, Hypoxia, Influenza, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-04
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unlnown Unlnown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client passed away on 2/4/2020 at 0832 AM. Cause of death states hypoxia, respiratory failure, cardiac arrest and influenza. Unknown if the vaccines were linked to death in anyway. Reported due to close timing the vaccines were administered to death.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=860962&WAYBACKHISTORY=ON

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