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This is VAERS ID 893464

History of Changes from the VAERS Wayback Machine

First Appeared on 12/10/2020

VAERS ID: 893464
VAERS Form:2
Age:14.0
Sex:Male
Location:Rhode Island
Vaccinated:2020-10-27
Onset:2020-10-28
Submitted:0000-00-00
Entered:2020-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 542MY / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-10-28
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: Atrovent, baclofen, Famotidine, flonase, gabapentin, glycopyrrolate, lansoprazole, montelukast, oxcarbazepine, miralax, sennosides, tizanidine, Pediasure Peptide 1.5 nutritional formula PRN: tylenol, motrin, diastat
Current Illness: Increase in spasticity Elevated blood pressure
Preexisting Conditions: Spastic Quadriplegia, Feeding tube dependence (J Tube placed), malnutrition, sliding hiatal hernia, GERD, epilepsy, dysphagia, constipation, tracheobronhomalacia, visual impairment,
Allergies: Seasonal allergies No allergies to food, medications, products
Diagnostic Lab Data: Noe
CDC 'Split Type':

Write-up: Patient was put to bed at 10pm in his usual state of health. Parents found him unresponsive at 1am when they went to check on him per family routine. EMS was called. He was brought to the ER and was pronounced dead.


Changed on 12/24/2020

VAERS ID: 893464 Before After
VAERS Form:2
Age:14.0
Sex:Male
Location:Rhode Island
Vaccinated:2020-10-27
Onset:2020-10-28
Submitted:0000-00-00
Entered:2020-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 542MY / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-10-28
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: Atrovent, baclofen, Famotidine, flonase, gabapentin, glycopyrrolate, lansoprazole, montelukast, oxcarbazepine, miralax, sennosides, tizanidine, Pediasure Peptide 1.5 nutritional formula PRN: tylenol, motrin, diastat
Current Illness: Increase in spasticity Elevated blood pressure
Preexisting Conditions: Spastic Quadriplegia, Feeding tube dependence (J Tube placed), malnutrition, sliding hiatal hernia, GERD, epilepsy, dysphagia, constipation, tracheobronhomalacia, visual impairment,
Allergies: Seasonal allergies No allergies to food, medications, products products
Diagnostic Lab Data: Noe
CDC 'Split Type':

Write-up: Patient was put to bed at 10pm in his usual state of health. Parents found him unresponsive at 1am when they went to check on him per family routine. EMS was called. He was brought to the ER and was pronounced dead.


Changed on 12/30/2020

VAERS ID: 893464 Before After
VAERS Form:2
Age:14.0
Sex:Male
Location:Rhode Island
Vaccinated:2020-10-27
Onset:2020-10-28
Submitted:0000-00-00
Entered:2020-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 542MY / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-10-28
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: Atrovent, baclofen, Famotidine, flonase, gabapentin, glycopyrrolate, lansoprazole, montelukast, oxcarbazepine, miralax, sennosides, tizanidine, Pediasure Peptide 1.5 nutritional formula PRN: tylenol, motrin, diastat
Current Illness: Increase in spasticity Elevated blood pressure
Preexisting Conditions: Spastic Quadriplegia, Feeding tube dependence (J Tube placed), malnutrition, sliding hiatal hernia, GERD, epilepsy, dysphagia, constipation, tracheobronhomalacia, visual impairment,
Allergies: Seasonal allergies No allergies to food, medications, products products
Diagnostic Lab Data: Noe
CDC 'Split Type':

Write-up: Patient was put to bed at 10pm in his usual state of health. Parents found him unresponsive at 1am when they went to check on him per family routine. EMS was called. He was brought to the ER and was pronounced dead.

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