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This is VAERS ID 890866

History of Changes from the VAERS Wayback Machine

First Appeared on 12/10/2020

VAERS ID: 890866
VAERS Form:2
Age:87.0
Sex:Male
Location:Florida
Vaccinated:2020-09-28
Onset:2020-09-29
Submitted:0000-00-00
Entered:2020-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR U5516AA / 2 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatine phosphokinase increased, Death, Rhabdomyolysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received a call from beach saying that this patient died. Wife said that she believes it was as a result of a flu-clinic done on 9/28/20 where the patient received a flu-shot. She said that the patient was found dead in his room. Doctor said that he had elevated CPK levels. He died as a result of rhabdomyolysis. Patient''s wife said it was the flu-shot that killed him.


Changed on 12/24/2020

VAERS ID: 890866 Before After
VAERS Form:2
Age:87.0
Sex:Male
Location:Florida
Vaccinated:2020-09-28
Onset:2020-09-29
Submitted:0000-00-00
Entered:2020-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR U5516AA / 2 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatine phosphokinase increased, Death, Rhabdomyolysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received a call from beach saying that this patient died. Wife said that she believes it was as a result of a flu-clinic done on 9/28/20 where the patient received a flu-shot. She said that the patient was found dead in his room. Doctor said that he had elevated CPK levels. He died as a result of rhabdomyolysis. Patient''s wife said it was the flu-shot that killed him.


Changed on 12/30/2020

VAERS ID: 890866 Before After
VAERS Form:2
Age:87.0
Sex:Male
Location:Florida
Vaccinated:2020-09-28
Onset:2020-09-29
Submitted:0000-00-00
Entered:2020-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR U5516AA / 2 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatine phosphokinase increased, Death, Rhabdomyolysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received a call from beach saying that this patient died. Wife said that she believes it was as a result of a flu-clinic done on 9/28/20 where the patient received a flu-shot. She said that the patient was found dead in his room. Doctor said that he had elevated CPK levels. He died as a result of rhabdomyolysis. Patient''s wife said it was the flu-shot that killed him.


Changed on 5/7/2021

VAERS ID: 890866 Before After
VAERS Form:2
Age:87.0
Sex:Male
Location:Florida
Vaccinated:2020-09-28
Onset:2020-09-29
Submitted:0000-00-00
Entered:2020-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR U5516AA / 2 AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatine phosphokinase increased, Death, Rhabdomyolysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received a call from beach saying that this patient died. Wife said that she believes it was as a result of a flu-clinic done on 9/28/20 where the patient received a flu-shot. She said that the patient was found dead in his room. Doctor said that he had elevated CPK levels. He died as a result of rhabdomyolysis. Patient''s wife said it was the flu-shot that killed him.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=890866&WAYBACKHISTORY=ON


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