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History of Changes from the VAERS Wayback Machine |
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
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;
Current Illness:
Preexisting Conditions: pt had carcinoma of the colon which was resected 2NOV95;
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;
Link To This Search Result:
https://medalerts.org/vaersdb/findfield.php?IDNUMBER=86649&WAYBACKHISTORY=ON
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