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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 91623 |
VAERS Form: | |
Age: | 96.2 |
Sex: | Female |
Location: | New Hampshire |
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-06 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: FLUOGEN 1996-1997 / PARKE-DAVIS | 00986P / 0 | A / IM |
Administered by: Private Purchased by: Unknown
Symptoms: AGITATION, FEVER, APNEA, EDEMA LUNG, HEART FAIL RIGHT
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type':
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-06 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: FLUOGEN 1996-1997 INFLUENZA (SEASONAL) (FLUOGEN 96-97) / PARKE-DAVIS | 00986P / 0 | A / IM |
Administered by: Private Purchased by: Unknown Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence, AGITATION, FEVER, APNEA, EDEMA LUNG, HEART FAIL RIGHT
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': (blank) 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: INFLUENZA (SEASONAL) (FLUOGEN 96-97) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 0 | A / IM |
Administered by: Private Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 0 | A / IM |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 0 | A / IM |
Administered by: Private Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 0 | A / IM |
Administered by: Private Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 0 | A - / IM IM A |
Administered by: Private Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: ~ ()~~~In patient
Other Medications: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 0 1 | - / IM A |
Administered by: Private Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: ~ ()~~~In patient
Other Medications: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 1 | - / IM A |
Administered by: Private Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: ~ ()~~~In patient
Other Medications: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 1 | - / IM A |
Administered by: Private Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: ~ ()~~~In patient
Other Medications: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 1 | - / IM A |
Administered by: Private Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: ~ ()~~~In patient
Other Medications: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 1 | - / IM A |
Administered by: Private Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: ~ ()~~~In patient
Other Medications: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 1 | - / IM A |
Administered by: Private Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: ~ ()~~~In patient
Other Medications: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 1 | - / IM A |
Administered by: Private Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: ~ ()~~~In patient
Other Medications: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Vaccinated: | 1996-10-16 |
Onset: | 1996-10-18 |
Submitted: | 1996-10-24 |
Entered: | 1996-11-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS | 00986P / 1 | - / IM A |
Administered by: Private Purchased by: Other
Symptoms: Agitation, Apnoea, Hypotension, Lung disorder, Pulmonary oedema, Pyrexia, Right ventricular failure, Somnolence
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:1996-10-19
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: ~ ()~~~In patient
Other Medications: Verapamil, Percocet
Current Illness: NONE
Preexisting Conditions: hx of HTN, dementia, arthritis, vaginosis, atrial flutter, NKA;
Allergies:
Diagnostic Lab Data: NONE PROVIDED;
CDC 'Split Type': 0010150960037
Write-up: pt recv vax 16OCT96 & devel a low grade temp of 99.5;18OCT96 pt devel rales in both lobes, a BP of 90/40, periods of apnea lasting 3 to 4 sec & sleepiness alternated w/restlessness;
Link To This Search Result:
https://medalerts.org/vaersdb/findfield.php?IDNUMBER=91623&WAYBACKHISTORY=ON
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