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This is VAERS ID 94611

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 94611
VAERS Form:
Age:81.0
Sex:Male
Location:New Jersey
Vaccinated:1996-11-21
Onset:1996-11-23
Submitted:1997-01-29
Entered:1997-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1996-1997 / MEDEVA PHARMS LI E10660 / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: ASTHENIA, DYSPHAGIA, HYPOXIA, HEM, ESOPHAGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-17
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? Yes, days: 56     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


Changed on 12/8/2009

VAERS ID: 94611 Before After
VAERS Form:
Age:81.0
Sex:Male
Location:New Jersey
Vaccinated:1996-11-21
Onset:1996-11-23
Submitted:1997-01-29
Entered:1997-02-05 1997-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1996-1997 INFLUENZA (SEASONAL) (FLUVIRIN 96-97) / MEDEVA PHARMS LI MEDEVA PHARMA, LTD. E10660 / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Asthenia, Dysphagia, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock, Haemorrhage, ASTHENIA, DYSPHAGIA, HYPOXIA, HEM, ESOPHAGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-17
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? Yes, days: 56     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


Changed on 8/31/2010

VAERS ID: 94611 Before After
VAERS Form:
Age:81.0
Sex:Male
Location:New Jersey
Vaccinated:1996-11-21
Onset:1996-11-23
Submitted:1997-01-29
Entered:1997-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN 96-97) INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysphagia, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-17
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? Yes, days: 56     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


Changed on 7/7/2013

VAERS ID: 94611 Before After
VAERS Form:
Age:81.0
Sex:Male
Location:New Jersey
Vaccinated:1996-11-21
Onset:1996-11-23
Submitted:1997-01-29
Entered:1997-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysphagia, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-17
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? Yes, days: 56     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


Changed on 5/14/2017

VAERS ID: 94611 Before After
VAERS Form:
Age:81.0
Sex:Male
Location:New Jersey
Vaccinated:1996-11-21
Onset:1996-11-23
Submitted:1997-01-29
Entered:1997-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysphagia, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-17
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? Yes, days: 56     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


Changed on 9/14/2017

VAERS ID: 94611 Before After
VAERS Form:(blank) 1
Age:81.0
Sex:Male
Location:New Jersey
Vaccinated:1996-11-21
Onset:1996-11-23
Submitted:1997-01-29
Entered:1997-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysphagia, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-17
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? Yes, days: 56     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


Changed on 2/14/2018

VAERS ID: 94611 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:New Jersey
Vaccinated:1996-11-21
Onset:1996-11-23
Submitted:1997-01-29
Entered:1997-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysphagia, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-17
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? Yes, days: 56     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


Changed on 6/14/2018

VAERS ID: 94611 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:New Jersey
Vaccinated:1996-11-21
Onset:1996-11-23
Submitted:1997-01-29
Entered:1997-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysphagia, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-17
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? Yes, days: 56     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


Changed on 8/14/2018

VAERS ID: 94611 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:New Jersey
Vaccinated:1996-11-21
Onset:1996-11-23
Submitted:1997-01-29
Entered:1997-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysphagia, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-17
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? Yes, days: 56     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


Changed on 9/14/2018

VAERS ID: 94611 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:New Jersey
Vaccinated:1996-11-21
Onset:1996-11-23
Submitted:1997-01-29
Entered:1997-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysphagia, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-17
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? Yes, days: 56     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP


Changed on 10/14/2018

VAERS ID: 94611 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:New Jersey
Vaccinated:1996-11-21
Onset:1996-11-23
Submitted:1997-01-29
Entered:1997-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E10660 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysphagia, Hypoxia, Oesophageal ulcer, Oesophagitis, Sepsis, Shock, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-17
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? Yes, days: 56     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Cytotec/misoprostol;Ibuprofen, ATB, heparin
Current Illness:
Preexisting Conditions: rheumatoid arthritis:ongoing hx of rheumatoid arthritis for 2-3 yr;pt had hip fracture;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MPI97036

Write-up: exp weakness & collapsed 2 days p/vax;pt adm to hosp & found to have E coli in blood;devel thrush & esophagitis & diff swallowing & a esophageal ulcer was suspected;HGB dec from 11.8 to 8.0;pt was losing blood;pt devel resp failure;BP

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