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This is VAERS ID 94506

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 94506
VAERS Form:
Age:80.3
Sex:Male
Location:Pennsylvania
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted:1997-01-26
Entered:1997-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1996-1997 / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: SOMNOLENCE, RHINITIS, ANOREXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': allergy PCN

Write-up: congested, lethargic, not eating;


Changed on 12/8/2009

VAERS ID: 94506 Before After
VAERS Form:
Age:80.3
Sex:Male
Location:Pennsylvania
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted:1997-01-26
Entered:1997-02-07 1997-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1996-1997 INFLUENZA (SEASONAL) (FLUOGEN 96-97) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Anorexia, Rhinitis, Somnolence, SOMNOLENCE, RHINITIS, ANOREXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': allergy PCN (blank)

Write-up: congested, lethargic, not eating;


Changed on 8/31/2010

VAERS ID: 94506 Before After
VAERS Form:
Age:80.3
Sex:Male
Location:Pennsylvania
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted:1997-01-26
Entered:1997-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 96-97) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Rhinitis, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: congested, lethargic, not eating;


Changed on 7/7/2013

VAERS ID: 94506 Before After
VAERS Form:
Age:80.3
Sex:Male
Location:Pennsylvania
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted:1997-01-26
Entered:1997-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Rhinitis, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: congested, lethargic, not eating;


Changed on 2/14/2017

VAERS ID: 94506 Before After
VAERS Form:
Age:80.3 80.0
Sex:Male
Location:Pennsylvania
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted:1997-01-26
Entered:1997-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Rhinitis, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: congested, lethargic, not eating;


Changed on 5/14/2017

VAERS ID: 94506 Before After
VAERS Form:
Age:80.0
Sex:Male
Location:Pennsylvania
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted:1997-01-26
Entered:1997-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Rhinitis, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: congested, lethargic, not eating;


Changed on 9/14/2017

VAERS ID: 94506 Before After
VAERS Form:(blank) 1
Age:80.0
Sex:Male
Location:Pennsylvania
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted:1997-01-26
Entered:1997-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Rhinitis, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: congested, lethargic, not eating;


Changed on 2/14/2018

VAERS ID: 94506 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Pennsylvania
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted:1997-01-26
Entered:1997-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Rhinitis, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: congested, lethargic, not eating;


Changed on 6/14/2018

VAERS ID: 94506 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Pennsylvania
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted:1997-01-26
Entered:1997-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Rhinitis, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: congested, lethargic, not eating;


Changed on 8/14/2018

VAERS ID: 94506 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Pennsylvania
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted:1997-01-26
Entered:1997-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Rhinitis, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: congested, lethargic, not eating;


Changed on 9/14/2018

VAERS ID: 94506 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Pennsylvania
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted:1997-01-26
Entered:1997-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Rhinitis, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: congested, lethargic, not eating;


Changed on 10/14/2018

VAERS ID: 94506 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Pennsylvania
Vaccinated:1996-10-03
Onset:0000-00-00
Submitted:1997-01-26
Entered:1997-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Anorexia, Rhinitis, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergy PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: congested, lethargic, not eating;

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