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This is VAERS ID 93968

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 93968
VAERS Form:
Age:66.0
Sex:Male
Location:Massachusetts
Vaccinated:1996-10-24
Onset:1996-10-25
Submitted:1996-11-01
Entered:1997-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1996-1997 / CONNAUGHT LABS 6F71226 / - A / IM

Administered by: Public      Purchased by: Unknown
Symptoms: APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-25
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: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


Changed on 12/8/2009

VAERS ID: 93968 Before After
VAERS Form:
Age:66.0
Sex:Male
Location:Massachusetts
Vaccinated:1996-10-24
Onset:1996-10-25
Submitted:1996-11-01
Entered:1997-01-24 1997-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1996-1997 INFLUENZA (SEASONAL) (FLUZONE 96-97) / CONNAUGHT LABS CONNAUGHT LABORATORIES 6F71226 / - A / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Apnoea, Cardiac arrest, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-25
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: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


Changed on 8/31/2010

VAERS ID: 93968 Before After
VAERS Form:
Age:66.0
Sex:Male
Location:Massachusetts
Vaccinated:1996-10-24
Onset:1996-10-25
Submitted:1996-11-01
Entered:1997-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 96-97) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / - A / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-25
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: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


Changed on 7/7/2013

VAERS ID: 93968 Before After
VAERS Form:
Age:66.0
Sex:Male
Location:Massachusetts
Vaccinated:1996-10-24
Onset:1996-10-25
Submitted:1996-11-01
Entered:1997-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / - A / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / - A / IM

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-25
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: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


Changed on 5/14/2017

VAERS ID: 93968 Before After
VAERS Form:
Age:66.0
Sex:Male
Location:Massachusetts
Vaccinated:1996-10-24
Onset:1996-10-25
Submitted:1996-11-01
Entered:1997-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / - A - / IM IM A

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-25
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:
Current Illness:
Preexisting Conditions: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


Changed on 9/14/2017

VAERS ID: 93968 Before After
VAERS Form:(blank) 1
Age:66.0
Sex:Male
Location:Massachusetts
Vaccinated:1996-10-24
Onset:1996-10-25
Submitted:1996-11-01
Entered:1997-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / - UNK - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-25
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:
Current Illness:
Preexisting Conditions: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


Changed on 2/14/2018

VAERS ID: 93968 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Massachusetts
Vaccinated:1996-10-24
Onset:1996-10-25
Submitted:1996-11-01
Entered:1997-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / UNK - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-25
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:
Current Illness:
Preexisting Conditions: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


Changed on 6/14/2018

VAERS ID: 93968 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Massachusetts
Vaccinated:1996-10-24
Onset:1996-10-25
Submitted:1996-11-01
Entered:1997-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / UNK - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-25
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:
Current Illness:
Preexisting Conditions: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


Changed on 8/14/2018

VAERS ID: 93968 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Massachusetts
Vaccinated:1996-10-24
Onset:1996-10-25
Submitted:1996-11-01
Entered:1997-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / UNK - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-25
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:
Current Illness:
Preexisting Conditions: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


Changed on 9/14/2018

VAERS ID: 93968 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Massachusetts
Vaccinated:1996-10-24
Onset:1996-10-25
Submitted:1996-11-01
Entered:1997-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / UNK - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-25
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:
Current Illness:
Preexisting Conditions: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;


Changed on 10/14/2018

VAERS ID: 93968 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Massachusetts
Vaccinated:1996-10-24
Onset:1996-10-25
Submitted:1996-11-01
Entered:1997-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71226 / UNK - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-10-25
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:
Current Illness:
Preexisting Conditions: HTN (as noted on death certificate);
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MA9632

Write-up: no adverse event reported 25OCT96 pt expired-cardiac arrest;

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