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This is VAERS ID 881505

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2020

VAERS ID: 881505
VAERS Form:2
Age:72.0
Sex:Female
Location:Iowa
Vaccinated:2020-08-29
Onset:2020-08-29
Submitted:0000-00-00
Entered:2020-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ454SB / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-08-29
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Pulmonary eosinophilia, asthma, GERD, type 2 diabetes mellitus, COPD
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Patient found unresponsive in pharmacy parking lot 4 hours later


Changed on 12/24/2020

VAERS ID: 881505 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Iowa
Vaccinated:2020-08-29
Onset:2020-08-29
Submitted:0000-00-00
Entered:2020-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ454SB / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-08-29
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Pulmonary eosinophilia, asthma, GERD, type 2 diabetes mellitus, COPD
Allergies: No known drug allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Patient found unresponsive in pharmacy parking lot 4 hours later


Changed on 12/30/2020

VAERS ID: 881505 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Iowa
Vaccinated:2020-08-29
Onset:2020-08-29
Submitted:0000-00-00
Entered:2020-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ454SB / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-08-29
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Pulmonary eosinophilia, asthma, GERD, type 2 diabetes mellitus, COPD
Allergies: No known drug allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Patient found unresponsive in pharmacy parking lot 4 hours later

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=881505&WAYBACKHISTORY=ON


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