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This is VAERS ID 900124

History of Changes from the VAERS Wayback Machine

First Appeared on 12/10/2020

VAERS ID: 900124
VAERS Form:2
Age:91.0
Sex:Male
Location:Florida
Vaccinated:2020-09-15
Onset:2020-09-15
Submitted:0000-00-00
Entered:2020-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 279793 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Death, Feeling cold

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-09-17
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: Clopidogrel 75mg once a day, Rosuvastatin 10mg once a day
Current Illness:
Preexisting Conditions:
Allergies: no allergies to medications
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient relayed to daughter that he was cold and was having chills. He stated he was going to take a shower. He passed away sometime after this and was found 2 days later per his daughter. Date of death was listed as 9/17/2020 on death certificate.


Changed on 12/24/2020

VAERS ID: 900124 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:Florida
Vaccinated:2020-09-15
Onset:2020-09-15
Submitted:0000-00-00
Entered:2020-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 279793 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Death, Feeling cold

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-09-17
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: Clopidogrel 75mg once a day, Rosuvastatin 10mg once a day
Current Illness:
Preexisting Conditions:
Allergies: no allergies to medications medications
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient relayed to daughter that he was cold and was having chills. He stated he was going to take a shower. He passed away sometime after this and was found 2 days later per his daughter. Date of death was listed as 9/17/2020 on death certificate.


Changed on 12/30/2020

VAERS ID: 900124 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:Florida
Vaccinated:2020-09-15
Onset:2020-09-15
Submitted:0000-00-00
Entered:2020-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 279793 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Death, Feeling cold

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-09-17
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: Clopidogrel 75mg once a day, Rosuvastatin 10mg once a day
Current Illness:
Preexisting Conditions:
Allergies: no allergies to medications medications
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient relayed to daughter that he was cold and was having chills. He stated he was going to take a shower. He passed away sometime after this and was found 2 days later per his daughter. Date of death was listed as 9/17/2020 on death certificate.


Changed on 5/7/2021

VAERS ID: 900124 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:Florida
Vaccinated:2020-09-15
Onset:2020-09-15
Submitted:0000-00-00
Entered:2020-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 279793 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Death, Feeling cold

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-09-17
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: Clopidogrel 75mg once a day, Rosuvastatin 10mg once a day
Current Illness:
Preexisting Conditions:
Allergies: no allergies to medications medications
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient relayed to daughter that he was cold and was having chills. He stated he was going to take a shower. He passed away sometime after this and was found 2 days later per his daughter. Date of death was listed as 9/17/2020 on death certificate.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=900124&WAYBACKHISTORY=ON


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