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This is VAERS ID 90265

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 90265
VAERS Form:
Age:52.3
Sex:Male
Location:California
Vaccinated:1996-09-18
Onset:1996-09-22
Submitted:1996-09-27
Entered:1996-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED 6F71223 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: ALLERG REACT, FLU SYND, ANAPHYL, EDEMA LARYNX, ASPHYXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death, flu-like sx 3 days p/shot;


Changed on 12/8/2009

VAERS ID: 90265 Before After
VAERS Form:
Age:52.3 52.0
Sex:Male
Location:California
Vaccinated:1996-09-18
Onset:1996-09-22
Submitted:1996-09-27
Entered:1996-10-02 1996-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 6F71223 / - - / -

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema, ALLERG REACT, FLU SYND, ANAPHYL, EDEMA LARYNX, ASPHYXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CO6786

Write-up: death, flu-like sx 3 days p/shot;


Changed on 7/7/2013

VAERS ID: 90265 Before After
VAERS Form:
Age:52.0
Sex:Male
Location:California
Vaccinated:1996-09-18
Onset:1996-09-22
Submitted:1996-09-27
Entered:1996-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO6786

Write-up: death, flu-like sx 3 days p/shot;


Changed on 12/14/2016

VAERS ID: 90265 Before After
VAERS Form:
Age:52.0
Sex:Male
Location:California
Vaccinated:1996-09-18
Onset:1996-09-22
Submitted:1996-09-27
Entered:1996-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO6786

Write-up: death, flu-like sx 3 days p/shot;


Changed on 5/14/2017

VAERS ID: 90265 Before After
VAERS Form:
Age:52.0
Sex:Male
Location:California
Vaccinated:1996-09-18
Onset:1996-09-22
Submitted:1996-09-27
Entered:1996-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / - - / -

Administered by: Unknown Private      Purchased by: Unknown Private
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO6786

Write-up: death, flu-like sx 3 days p/shot;


Changed on 9/14/2017

VAERS ID: 90265 Before After
VAERS Form:(blank) 1
Age:52.0
Sex:Male
Location:California
Vaccinated:1996-09-18
Onset:1996-09-22
Submitted:1996-09-27
Entered:1996-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO6786

Write-up: death, flu-like sx 3 days p/shot;


Changed on 2/14/2018

VAERS ID: 90265 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:California
Vaccinated:1996-09-18
Onset:1996-09-22
Submitted:1996-09-27
Entered:1996-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO6786

Write-up: death, flu-like sx 3 days p/shot;


Changed on 6/14/2018

VAERS ID: 90265 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:California
Vaccinated:1996-09-18
Onset:1996-09-22
Submitted:1996-09-27
Entered:1996-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO6786

Write-up: death, flu-like sx 3 days p/shot;


Changed on 8/14/2018

VAERS ID: 90265 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:California
Vaccinated:1996-09-18
Onset:1996-09-22
Submitted:1996-09-27
Entered:1996-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO6786

Write-up: death, flu-like sx 3 days p/shot;


Changed on 9/14/2018

VAERS ID: 90265 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:California
Vaccinated:1996-09-18
Onset:1996-09-22
Submitted:1996-09-27
Entered:1996-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO6786

Write-up: death, flu-like sx 3 days p/shot;


Changed on 10/14/2018

VAERS ID: 90265 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:California
Vaccinated:1996-09-18
Onset:1996-09-22
Submitted:1996-09-27
Entered:1996-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 6F71223 / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Anaphylactoid reaction, Asphyxia, Hypersensitivity, Influenza, Laryngeal oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO6786

Write-up: death, flu-like sx 3 days p/shot;

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