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This is VAERS ID 890067

History of Changes from the VAERS Wayback Machine

First Appeared on 12/10/2020

VAERS ID: 890067
VAERS Form:2
Age:83.0
Sex:Male
Location:Nevada
Vaccinated:2020-09-08
Onset:2020-09-08
Submitted:0000-00-00
Entered:2020-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ460AB / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 4F99G / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-10-12
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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Diabetes, CVD, and hyperlipidemia
Allergies: NOne
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Wife called us on 10/15 to inform that patient did not do well after the vaccines. He was on ventilator for 5 days, then passed away.


Changed on 12/24/2020

VAERS ID: 890067 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Nevada
Vaccinated:2020-09-08
Onset:2020-09-08
Submitted:0000-00-00
Entered:2020-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ460AB / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 4F99G / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-10-12
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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Diabetes, CVD, and hyperlipidemia
Allergies: NOne NOne
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Wife called us on 10/15 to inform that patient did not do well after the vaccines. He was on ventilator for 5 days, then passed away.


Changed on 12/30/2020

VAERS ID: 890067 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:Nevada
Vaccinated:2020-09-08
Onset:2020-09-08
Submitted:0000-00-00
Entered:2020-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ460AB / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 4F99G / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-10-12
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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Diabetes, CVD, and hyperlipidemia
Allergies: NOne NOne
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Wife called us on 10/15 to inform that patient did not do well after the vaccines. He was on ventilator for 5 days, then passed away.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=890067&WAYBACKHISTORY=ON


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