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This is VAERS ID 94662

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 94662
VAERS Form:
Age:43.9
Sex:Male
Location:South Carolina
Vaccinated:1996-12-20
Onset:1996-12-20
Submitted:1996-12-31
Entered:1997-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1996-1997 / CONNAUGHT LABS 6F71316 / 1 A / IM

Administered by: Public      Purchased by: Unknown
Symptoms: HYPOTENS, PAIN BACK, DYSPNEA, PAIN CHEST, MYOCARDITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-20
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: unk
Other Medications:
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': asthma

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


Changed on 12/8/2009

VAERS ID: 94662 Before After
VAERS Form:
Age:43.9 43.0
Sex:Male
Location:South Carolina
Vaccinated:1996-12-20
Onset:1996-12-20
Submitted:1996-12-31
Entered:1997-02-11 1997-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1996-1997 INFLUENZA (SEASONAL) (FLUZONE 96-97) / CONNAUGHT LABS CONNAUGHT LABORATORIES 6F71316 / 1 A - / IM

Administered by: Public Unknown      Purchased by: Unknown
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis, HYPOTENS, PAIN BACK, DYSPNEA, PAIN CHEST, MYOCARDITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-20
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: unk
Other Medications:
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': asthma SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


Changed on 8/31/2010

VAERS ID: 94662 Before After
VAERS Form:
Age:43.0
Sex:Male
Location:South Carolina
Vaccinated:1996-12-20
Onset:1996-12-20
Submitted:1996-12-31
Entered:1997-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 96-97) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-20
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: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


Changed on 7/7/2013

VAERS ID: 94662 Before After
VAERS Form:
Age:43.0
Sex:Male
Location:South Carolina
Vaccinated:1996-12-20
Onset:1996-12-20
Submitted:1996-12-31
Entered:1997-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 1 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-20
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: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


Changed on 5/14/2017

VAERS ID: 94662 Before After
VAERS Form:
Age:43.0
Sex:Male
Location:South Carolina
Vaccinated:1996-12-20
Onset:1996-12-20
Submitted:1996-12-31
Entered:1997-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 1 - / IM

Administered by: Unknown Public      Purchased by: Unknown Public
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-20
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: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


Changed on 9/14/2017

VAERS ID: 94662 Before After
VAERS Form:(blank) 1
Age:43.0
Sex:Male
Location:South Carolina
Vaccinated:1996-12-20
Onset:1996-12-20
Submitted:1996-12-31
Entered:1997-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 1 2 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-20
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: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


Changed on 2/14/2018

VAERS ID: 94662 Before After
VAERS Form:1
Age:43.0
Sex:Male
Location:South Carolina
Vaccinated:1996-12-20
Onset:1996-12-20
Submitted:1996-12-31
Entered:1997-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 2 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-20
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: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


Changed on 6/14/2018

VAERS ID: 94662 Before After
VAERS Form:1
Age:43.0
Sex:Male
Location:South Carolina
Vaccinated:1996-12-20
Onset:1996-12-20
Submitted:1996-12-31
Entered:1997-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 2 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-20
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: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


Changed on 8/14/2018

VAERS ID: 94662 Before After
VAERS Form:1
Age:43.0
Sex:Male
Location:South Carolina
Vaccinated:1996-12-20
Onset:1996-12-20
Submitted:1996-12-31
Entered:1997-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 2 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-20
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: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


Changed on 9/14/2018

VAERS ID: 94662 Before After
VAERS Form:1
Age:43.0
Sex:Male
Location:South Carolina
Vaccinated:1996-12-20
Onset:1996-12-20
Submitted:1996-12-31
Entered:1997-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 2 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-20
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: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;


Changed on 10/14/2018

VAERS ID: 94662 Before After
VAERS Form:1
Age:43.0
Sex:Male
Location:South Carolina
Vaccinated:1996-12-20
Onset:1996-12-20
Submitted:1996-12-31
Entered:1997-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71316 / 2 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Back pain, Chest pain, Dyspnoea, Hyperhidrosis, Hypotension, Myocarditis, Pallor, Pericarditis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-20
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: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': SC96071

Write-up: pt recv vax 20DEC96 1230PM & pt became pale, sweating profusely & was in pain (both chest & jaw) & SOB;EMS transported pt to local hosp ER:BP was 1/2 nl 90/50;died 830PM;

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=94662&WAYBACKHISTORY=ON


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