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This is VAERS ID 92463

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 92463
VAERS Form:
Age:95.1
Sex:Male
Location:Arizona
Vaccinated:1996-10-27
Onset:1996-10-31
Submitted:1996-11-01
Entered:1996-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1996-1997 / WYETH 4968162 / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: APNEA, DIARRHEA, HEART FAIL, HYPOXIA, ELECTROLYTE ABNORM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-31
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: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


Changed on 12/8/2009

VAERS ID: 92463 Before After
VAERS Form:
Age:95.1 95.0
Sex:Male
Location:Arizona
Vaccinated:1996-10-27
Onset:1996-10-31
Submitted:1996-11-01
Entered:1996-12-02 1996-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1996-1997 INFLUENZA (SEASONAL) (FLUSHIELD 96-97) / WYETH WYETH PHARMACEUTICALS, INC 4968162 / - - / IM

Administered by: Other Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting, APNEA, DIARRHEA, HEART FAIL, HYPOXIA, ELECTROLYTE ABNORM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-31
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: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


Changed on 8/31/2010

VAERS ID: 92463 Before After
VAERS Form:
Age:95.0
Sex:Male
Location:Arizona
Vaccinated:1996-10-27
Onset:1996-10-31
Submitted:1996-11-01
Entered:1996-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 96-97) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4968162 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-31
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: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


Changed on 7/7/2013

VAERS ID: 92463 Before After
VAERS Form:
Age:95.0
Sex:Male
Location:Arizona
Vaccinated:1996-10-27
Onset:1996-10-31
Submitted:1996-11-01
Entered:1996-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-31
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: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


Changed on 5/14/2017

VAERS ID: 92463 Before After
VAERS Form:
Age:95.0
Sex:Male
Location:Arizona
Vaccinated:1996-10-27
Onset:1996-10-31
Submitted:1996-11-01
Entered:1996-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / - - / IM

Administered by: Unknown Other      Purchased by: Unknown Other
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-31
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: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


Changed on 9/14/2017

VAERS ID: 92463 Before After
VAERS Form:(blank) 1
Age:95.0
Sex:Male
Location:Arizona
Vaccinated:1996-10-27
Onset:1996-10-31
Submitted:1996-11-01
Entered:1996-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-31
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: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


Changed on 2/14/2018

VAERS ID: 92463 Before After
VAERS Form:1
Age:95.0
Sex:Male
Location:Arizona
Vaccinated:1996-10-27
Onset:1996-10-31
Submitted:1996-11-01
Entered:1996-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-31
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: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


Changed on 6/14/2018

VAERS ID: 92463 Before After
VAERS Form:1
Age:95.0
Sex:Male
Location:Arizona
Vaccinated:1996-10-27
Onset:1996-10-31
Submitted:1996-11-01
Entered:1996-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-31
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: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


Changed on 8/14/2018

VAERS ID: 92463 Before After
VAERS Form:1
Age:95.0
Sex:Male
Location:Arizona
Vaccinated:1996-10-27
Onset:1996-10-31
Submitted:1996-11-01
Entered:1996-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-31
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: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


Changed on 9/14/2018

VAERS ID: 92463 Before After
VAERS Form:1
Age:95.0
Sex:Male
Location:Arizona
Vaccinated:1996-10-27
Onset:1996-10-31
Submitted:1996-11-01
Entered:1996-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-31
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: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;


Changed on 10/14/2018

VAERS ID: 92463 Before After
VAERS Form:1
Age:95.0
Sex:Male
Location:Arizona
Vaccinated:1996-10-27
Onset:1996-10-31
Submitted:1996-11-01
Entered:1996-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968162 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac failure, Diarrhoea, Electrolyte imbalance, Hypoxia, Syncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-31
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: unk
Current Illness: unk
Preexisting Conditions: HTN, dementia, seizure disorder, and prostate cancer
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 896309011L

Write-up: 1 of 2 pt from long-term care facility, out of 50 vaccinees, to die (of unspecified causes & p/an unspecified interval) following flu vax;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=92463&WAYBACKHISTORY=ON


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