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This is VAERS ID 893549

History of Changes from the VAERS Wayback Machine

First Appeared on 12/10/2020

VAERS ID: 893549
VAERS Form:2
Age:57.0
Sex:Female
Location:California
Vaccinated:2020-10-21
Onset:2020-10-25
Submitted:0000-00-00
Entered:2020-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS XJ3ZT / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Loss of consciousness, Malaise, Resuscitation, Sudden death, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-10-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: gabapentin, omeprazole, hydrocodone-acetaminophen, duloxetine, trazodone, cyclobenzaprine
Current Illness: oral lesion/growth that was scheduled for biopsy on 10/29/20
Preexisting Conditions: chronic migraine, interstitial cystitis, gerd, recurrent depression, anxiety
Allergies: none
Diagnostic Lab Data: As reported by daughter: no MI, no brain aneurysm, no PE, no intoxication
CDC 'Split Type':

Write-up: Sudden death on 10/25/20, 9:15AM. Patient''s adult daughter reports patient awoke on 10/25/20 AM feeling unwell and eventually lost consciousness. Had to be resuscitated and eventually intubated.


Changed on 12/24/2020

VAERS ID: 893549 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:California
Vaccinated:2020-10-21
Onset:2020-10-25
Submitted:0000-00-00
Entered:2020-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS XJ3ZT / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Loss of consciousness, Malaise, Resuscitation, Sudden death, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-10-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: gabapentin, omeprazole, hydrocodone-acetaminophen, duloxetine, trazodone, cyclobenzaprine
Current Illness: oral lesion/growth that was scheduled for biopsy on 10/29/20
Preexisting Conditions: chronic migraine, interstitial cystitis, gerd, recurrent depression, anxiety
Allergies: none none
Diagnostic Lab Data: As reported by daughter: no MI, no brain aneurysm, no PE, no intoxication
CDC 'Split Type':

Write-up: Sudden death on 10/25/20, 9:15AM. Patient''s adult daughter reports patient awoke on 10/25/20 AM feeling unwell and eventually lost consciousness. Had to be resuscitated and eventually intubated.


Changed on 12/30/2020

VAERS ID: 893549 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:California
Vaccinated:2020-10-21
Onset:2020-10-25
Submitted:0000-00-00
Entered:2020-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS XJ3ZT / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Loss of consciousness, Malaise, Resuscitation, Sudden death, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-10-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: gabapentin, omeprazole, hydrocodone-acetaminophen, duloxetine, trazodone, cyclobenzaprine
Current Illness: oral lesion/growth that was scheduled for biopsy on 10/29/20
Preexisting Conditions: chronic migraine, interstitial cystitis, gerd, recurrent depression, anxiety
Allergies: none none
Diagnostic Lab Data: As reported by daughter: no MI, no brain aneurysm, no PE, no intoxication
CDC 'Split Type':

Write-up: Sudden death on 10/25/20, 9:15AM. Patient''s adult daughter reports patient awoke on 10/25/20 AM feeling unwell and eventually lost consciousness. Had to be resuscitated and eventually intubated.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=893549&WAYBACKHISTORY=ON


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