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This is VAERS ID 86649

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 86649
VAERS Form:
Age:73.4
Sex:Male
Location:Maryland
Vaccinated:1995-11-27
Onset:1995-11-29
Submitted:1996-02-05
Entered:1996-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 / WYETH 4958066 / 1 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: MALAISE

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-29
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: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


Changed on 12/8/2009

VAERS ID: 86649 Before After
VAERS Form:
Age:73.4
Sex:Male
Location:Maryland
Vaccinated:1995-11-27
Onset:1995-11-29
Submitted:1996-02-05
Entered:1996-06-13 1996-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 INFLUENZA (SEASONAL) (FLUSHIELD 95-96) / WYETH WYETH PHARMACEUTICALS, INC 4958066 / 1 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Malaise, MALAISE

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-29
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: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


Changed on 8/31/2010

VAERS ID: 86649 Before After
VAERS Form:
Age:73.4
Sex:Male
Location:Maryland
Vaccinated:1995-11-27
Onset:1995-11-29
Submitted:1996-02-05
Entered:1996-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 95-96) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4958066 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-29
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: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


Changed on 7/7/2013

VAERS ID: 86649 Before After
VAERS Form:
Age:73.4
Sex:Male
Location:Maryland
Vaccinated:1995-11-27
Onset:1995-11-29
Submitted:1996-02-05
Entered:1996-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958066 / 1 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958066 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-29
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: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


Changed on 2/14/2017

VAERS ID: 86649 Before After
VAERS Form:
Age:73.4 73.0
Sex:Male
Location:Maryland
Vaccinated:1995-11-27
Onset:1995-11-29
Submitted:1996-02-05
Entered:1996-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958066 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-29
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: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


Changed on 5/14/2017

VAERS ID: 86649 Before After
VAERS Form:
Age:73.0
Sex:Male
Location:Maryland
Vaccinated:1995-11-27
Onset:1995-11-29
Submitted:1996-02-05
Entered:1996-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958066 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-29
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: ~ ()~~~In patient
Other Medications: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


Changed on 9/14/2017

VAERS ID: 86649 Before After
VAERS Form:(blank) 1
Age:73.0
Sex:Male
Location:Maryland
Vaccinated:1995-11-27
Onset:1995-11-29
Submitted:1996-02-05
Entered:1996-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958066 / 1 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-29
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: ~ ()~~~In patient
Other Medications: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


Changed on 2/14/2018

VAERS ID: 86649 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Maryland
Vaccinated:1995-11-27
Onset:1995-11-29
Submitted:1996-02-05
Entered:1996-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958066 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-29
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: ~ ()~~~In patient
Other Medications: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


Changed on 6/14/2018

VAERS ID: 86649 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Maryland
Vaccinated:1995-11-27
Onset:1995-11-29
Submitted:1996-02-05
Entered:1996-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958066 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-29
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: ~ ()~~~In patient
Other Medications: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


Changed on 8/14/2018

VAERS ID: 86649 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Maryland
Vaccinated:1995-11-27
Onset:1995-11-29
Submitted:1996-02-05
Entered:1996-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958066 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-29
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: ~ ()~~~In patient
Other Medications: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


Changed on 9/14/2018

VAERS ID: 86649 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Maryland
Vaccinated:1995-11-27
Onset:1995-11-29
Submitted:1996-02-05
Entered:1996-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958066 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-29
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: ~ ()~~~In patient
Other Medications: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;


Changed on 10/14/2018

VAERS ID: 86649 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Maryland
Vaccinated:1995-11-27
Onset:1995-11-29
Submitted:1996-02-05
Entered:1996-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958066 / 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-29
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: ~ ()~~~In patient
Other Medications: Benazepril HCL;Felodipine;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;no hx of heart disease in pt or family
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896038023L

Write-up: pt recv vax & 2 days later pt did not feel well & went to bed;pt died in sleep;no hx/evidence that pt exp heart arrhythmia, chest discomfort, fatigue or weakness during the interval between vax & death;no autopsy performed;COD unk;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=86649&WAYBACKHISTORY=ON


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