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This is VAERS ID 86285

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 86285
VAERS Form:
Age:71.3
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 / WYETH - / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, APNEA, HEART ARREST, COMA, HYPOVENTIL

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 12/8/2009

VAERS ID: 86285 Before After
VAERS Form:
Age:71.3
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-28 1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 INFLUENZA (SEASONAL) (FLUSHIELD 95-96) / WYETH WYETH PHARMACEUTICALS, INC - / - - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock, INFECT, APNEA, HEART ARREST, COMA, HYPOVENTIL

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 8/31/2010

VAERS ID: 86285 Before After
VAERS Form:
Age:71.3
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 95-96) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 7/7/2013

VAERS ID: 86285 Before After
VAERS Form:
Age:71.3
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 2/14/2017

VAERS ID: 86285 Before After
VAERS Form:
Age:71.3 71.0
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 5/14/2017

VAERS ID: 86285 Before After
VAERS Form:
Age:71.0
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 9/14/2017

VAERS ID: 86285 Before After
VAERS Form:(blank) 1
Age:71.0
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 2/14/2018

VAERS ID: 86285 Before After
VAERS Form:1
Age:71.0
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 6/14/2018

VAERS ID: 86285 Before After
VAERS Form:1
Age:71.0
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 8/14/2018

VAERS ID: 86285 Before After
VAERS Form:1
Age:71.0
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 9/14/2018

VAERS ID: 86285 Before After
VAERS Form:1
Age:71.0
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 10/14/2018

VAERS ID: 86285 Before After
VAERS Form:1
Age:71.0
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 12/24/2020

VAERS ID: 86285 Before After
VAERS Form:1
Age:71.0
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

Changed on 12/30/2020

VAERS ID: 86285 Before After
VAERS Form:1
Age:71.0
Sex:Male
Location:Florida
Vaccinated:1995-12-18
Onset:1995-12-19
Submitted:1996-01-02
Entered:1996-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Hypoventilation, Infection, Renal failure acute, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-12-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt was reportedly completely well prior to vax;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896005015L

Write-up: pt recv vax 18DEC95&next day became ill;pt hosp in a comatose state&placed on a ventilator;pt died next day;death allegedly d/t skin infect;death certificate stated COD cardiac arrest,assoc w/sepsis,shock,acute renal failure,resp failure

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=86285&WAYBACKHISTORY=ON


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