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This is VAERS ID 864321

History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2020

VAERS ID: 864321
VAERS Form:2
Age:88.0
Sex:Female
Location:Colorado
Vaccinated:2019-11-16
Onset:2019-11-17
Submitted:0000-00-00
Entered:2020-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ293AA / UNK UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Dehydration, Diarrhoea, Gastrointestinal disorder, Nausea, Sudden death, Vomiting, Acute cardiac event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-11-19
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: acidophilus, famotidine, potassium chloride ER, quetiapine, Ativan, tums
Current Illness: Was hospitalized for acute urinary retention, low grade fever with initial suspicion for pneumonia that was subsequently ruled out. Patient was discharged on 11/18/2019. During the hospital stay she had an influenza vaccine administered, Fluzone high dose lot #UJ293AA on 11/16/2019. She developed nausea, vomiting and diarrhea that her physician, MD was concerned could be related to the vaccine. The patient died suddenly at her assisted living facility while on the toilet on 11/19/2019. This was thought to be an acute cardiac event, possibly an arrhythmia related to dehydration she sustained due to the gastrointestinal symptoms she was experiencing.
Preexisting Conditions: hypertensive heart disease, cardiomegaly, GERD, anxiety, dementia, iron deficiency anemia
Allergies: NKDA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Nausea, vomiting and diarrhea 48-72 hours after administration of the vaccine. Unknown whether this was the result of the vaccination or something else. The patient was frail, had underlying heart conditions and died of a cardiac event which likely was related to dehydration sustained from these symptoms.


Changed on 12/24/2020

VAERS ID: 864321 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Colorado
Vaccinated:2019-11-16
Onset:2019-11-17
Submitted:0000-00-00
Entered:2020-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ293AA / UNK UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Dehydration, Diarrhoea, Gastrointestinal disorder, Nausea, Sudden death, Vomiting, Acute cardiac event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-11-19
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: acidophilus, famotidine, potassium chloride ER, quetiapine, Ativan, tums
Current Illness: Was hospitalized for acute urinary retention, low grade fever with initial suspicion for pneumonia that was subsequently ruled out. Patient was discharged on 11/18/2019. During the hospital stay she had an influenza vaccine administered, Fluzone high dose lot #UJ293AA on 11/16/2019. She developed nausea, vomiting and diarrhea that her physician, MD was concerned could be related to the vaccine. The patient died suddenly at her assisted living facility while on the toilet on 11/19/2019. This was thought to be an acute cardiac event, possibly an arrhythmia related to dehydration she sustained due to the gastrointestinal symptoms she was experiencing.
Preexisting Conditions: hypertensive heart disease, cardiomegaly, GERD, anxiety, dementia, iron deficiency anemia
Allergies: NKDA NKDA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Nausea, vomiting and diarrhea 48-72 hours after administration of the vaccine. Unknown whether this was the result of the vaccination or something else. The patient was frail, had underlying heart conditions and died of a cardiac event which likely was related to dehydration sustained from these symptoms.


Changed on 12/30/2020

VAERS ID: 864321 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Colorado
Vaccinated:2019-11-16
Onset:2019-11-17
Submitted:0000-00-00
Entered:2020-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ293AA / UNK UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Dehydration, Diarrhoea, Gastrointestinal disorder, Nausea, Sudden death, Vomiting, Acute cardiac event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-11-19
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: acidophilus, famotidine, potassium chloride ER, quetiapine, Ativan, tums
Current Illness: Was hospitalized for acute urinary retention, low grade fever with initial suspicion for pneumonia that was subsequently ruled out. Patient was discharged on 11/18/2019. During the hospital stay she had an influenza vaccine administered, Fluzone high dose lot #UJ293AA on 11/16/2019. She developed nausea, vomiting and diarrhea that her physician, MD was concerned could be related to the vaccine. The patient died suddenly at her assisted living facility while on the toilet on 11/19/2019. This was thought to be an acute cardiac event, possibly an arrhythmia related to dehydration she sustained due to the gastrointestinal symptoms she was experiencing.
Preexisting Conditions: hypertensive heart disease, cardiomegaly, GERD, anxiety, dementia, iron deficiency anemia
Allergies: NKDA NKDA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Nausea, vomiting and diarrhea 48-72 hours after administration of the vaccine. Unknown whether this was the result of the vaccination or something else. The patient was frail, had underlying heart conditions and died of a cardiac event which likely was related to dehydration sustained from these symptoms.

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