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History of Changes from the VAERS Wayback Machine |
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
Link To This Search Result:
https://medalerts.org/vaersdb/findfield.php?IDNUMBER=92463&WAYBACKHISTORY=ON
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