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This is VAERS ID 897563

History of Changes from the VAERS Wayback Machine

First Appeared on 12/10/2020

VAERS ID: 897563
VAERS Form:2
Age:49.0
Sex:Male
Location:Utah
Vaccinated:2020-11-17
Onset:2020-11-18
Submitted:0000-00-00
Entered:2020-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7011NA / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-11-18
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: Unknown
Allergies: No known allergies
Diagnostic Lab Data: Not known
CDC 'Split Type':

Write-up: Flu shot given on 11/17/2020 at 3:10 pm and patient died on 11/18/2020 at approx. 10:30 am at his home.


Changed on 12/24/2020

VAERS ID: 897563 Before After
VAERS Form:2
Age:49.0
Sex:Male
Location:Utah
Vaccinated:2020-11-17
Onset:2020-11-18
Submitted:0000-00-00
Entered:2020-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7011NA / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-11-18
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: Unknown
Allergies: No known allergies allergies
Diagnostic Lab Data: Not known
CDC 'Split Type':

Write-up: Flu shot given on 11/17/2020 at 3:10 pm and patient died on 11/18/2020 at approx. 10:30 am at his home.


Changed on 12/30/2020

VAERS ID: 897563 Before After
VAERS Form:2
Age:49.0
Sex:Male
Location:Utah
Vaccinated:2020-11-17
Onset:2020-11-18
Submitted:0000-00-00
Entered:2020-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7011NA / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-11-18
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: Unknown
Allergies: No known allergies allergies
Diagnostic Lab Data: Not known
CDC 'Split Type':

Write-up: Flu shot given on 11/17/2020 at 3:10 pm and patient died on 11/18/2020 at approx. 10:30 am at his home.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=897563&WAYBACKHISTORY=ON


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