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This is VAERS ID 96949

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 96949
VAERS Form:
Age:78.0
Sex:Male
Location:Texas
Vaccinated:1996-10-28
Onset:1996-10-28
Submitted:0000-00-00
Entered:1997-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: INFARCT MYOCARD, AV BLOCK COMP

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


Changed on 12/8/2009

VAERS ID: 96949 Before After
VAERS Form:
Age:78.0
Sex:Male
Location:Texas
Vaccinated:1996-10-28
Onset:1996-10-28
Submitted:0000-00-00
Entered:1997-04-21 1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction, INFARCT MYOCARD, AV BLOCK COMP

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


Changed on 7/7/2013

VAERS ID: 96949 Before After
VAERS Form:
Age:78.0
Sex:Male
Location:Texas
Vaccinated:1996-10-28
Onset:1996-10-28
Submitted:0000-00-00
Entered:1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


Changed on 12/14/2016

VAERS ID: 96949 Before After
VAERS Form:
Age:78.0
Sex:Male
Location:Texas
Vaccinated:1996-10-28
Onset:1996-10-28
Submitted:0000-00-00
Entered:1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


Changed on 5/14/2017

VAERS ID: 96949 Before After
VAERS Form:
Age:78.0
Sex:Male
Location:Texas
Vaccinated:1996-10-28
Onset:1996-10-28
Submitted:0000-00-00
Entered:1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


Changed on 9/14/2017

VAERS ID: 96949 Before After
VAERS Form:(blank) 1
Age:78.0
Sex:Male
Location:Texas
Vaccinated:1996-10-28
Onset:1996-10-28
Submitted:0000-00-00
Entered:1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


Changed on 2/14/2018

VAERS ID: 96949 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:Texas
Vaccinated:1996-10-28
Onset:1996-10-28
Submitted:0000-00-00
Entered:1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


Changed on 6/14/2018

VAERS ID: 96949 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:Texas
Vaccinated:1996-10-28
Onset:1996-10-28
Submitted:0000-00-00
Entered:1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


Changed on 8/14/2018

VAERS ID: 96949 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:Texas
Vaccinated:1996-10-28
Onset:1996-10-28
Submitted:0000-00-00
Entered:1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


Changed on 9/14/2018

VAERS ID: 96949 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:Texas
Vaccinated:1996-10-28
Onset:1996-10-28
Submitted:0000-00-00
Entered:1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);


Changed on 10/14/2018

VAERS ID: 96949 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:Texas
Vaccinated:1996-10-28
Onset:1996-10-28
Submitted:0000-00-00
Entered:1997-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block complete, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-05
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: Zestril, Tenormin, Trazodone;mult vit, calcium, vit C & E, metamucil;
Current Illness:
Preexisting Conditions: HTN, CAD, chronic renal insufficiency, depression;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & shortly p/vax pt died;MD does not feel shot contributed to death;pt recv flu vax prev w/no adverse effects;COD Myocardial rupture (immed) complete heart block (4 days) MI (5 days);

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=96949&WAYBACKHISTORY=ON


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