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This is VAERS ID 91791

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 91791
VAERS Form:
Age:79.1
Sex:Female
Location:Unknown
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-22
Entered:1996-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1996-1997 / WYETH - / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: NAUSEA, SYNCOPE, PAIN ABDO, DIARRHEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-17
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: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


Changed on 12/8/2009

VAERS ID: 91791 Before After
VAERS Form:
Age:79.1
Sex:Female
Location:Unknown
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-22
Entered:1996-11-11 1996-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1996-1997 INFLUENZA (SEASONAL) (FLUSHIELD 96-97) / WYETH WYETH PHARMACEUTICALS, INC - / - - / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope, NAUSEA, SYNCOPE, PAIN ABDO, DIARRHEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-17
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: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


Changed on 8/31/2010

VAERS ID: 91791 Before After
VAERS Form:
Age:79.1
Sex:Female
Location:Unknown
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-22
Entered:1996-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 96-97) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-17
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: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


Changed on 7/7/2013

VAERS ID: 91791 Before After
VAERS Form:
Age:79.1
Sex:Female
Location:Unknown
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-22
Entered:1996-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-17
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: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


Changed on 2/14/2017

VAERS ID: 91791 Before After
VAERS Form:
Age:79.1 79.0
Sex:Female
Location:Unknown
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-22
Entered:1996-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-17
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: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


Changed on 5/14/2017

VAERS ID: 91791 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Unknown
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-22
Entered:1996-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-17
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: ~ ()~~~In patient
Other Medications: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


Changed on 9/14/2017

VAERS ID: 91791 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Female
Location:Unknown
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-22
Entered:1996-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-17
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: ~ ()~~~In patient
Other Medications: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


Changed on 2/14/2018

VAERS ID: 91791 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Unknown
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-22
Entered:1996-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-17
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: ~ ()~~~In patient
Other Medications: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


Changed on 6/14/2018

VAERS ID: 91791 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Unknown
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-22
Entered:1996-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-17
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: ~ ()~~~In patient
Other Medications: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


Changed on 8/14/2018

VAERS ID: 91791 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Unknown
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-22
Entered:1996-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-17
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: ~ ()~~~In patient
Other Medications: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


Changed on 9/14/2018

VAERS ID: 91791 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Unknown
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-22
Entered:1996-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-17
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: ~ ()~~~In patient
Other Medications: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;


Changed on 10/14/2018

VAERS ID: 91791 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Unknown
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-22
Entered:1996-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Nausea, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-17
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: ~ ()~~~In patient
Other Medications: Cardizem, Cyodur,asthma shot, pred
Current Illness: unk
Preexisting Conditions: asthma, heart problems, arthritis, aortic aneurysm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896297025L

Write-up: pt recv vax 15OCT96 & 6PM on 17OCT96 pt fainted;upon arousal pt c.o stomach pain, diarrhea, & nausea;pt dies in home 8:45Pm;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=91791&WAYBACKHISTORY=ON


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