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This is VAERS ID 363458

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 363458
VAERS Form:
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (INFLUENZA A (H1N1) 2009 MONOVALENT) / SANOFI PASTEUR UP004AA / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Death, Dizziness, Fatigue, Obesity, Postnasal drip, Pulmonary embolism, Unresponsive to stimuli, Uterine leiomyoma, Weight decreased, Deep vein thrombosis, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 6/2/2010

VAERS ID: 363458 Before After
VAERS Form:
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (INFLUENZA A (H1N1) 2009 MONOVALENT) INFLUENZA (H1N1) (H1N1 (MONOVALENT) SANOFI) / SANOFI PASTEUR UP004AA / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Death, Dizziness, Fatigue, Obesity, Postnasal drip, Pulmonary embolism, Unresponsive to stimuli, Uterine leiomyoma, Weight decreased, Deep vein thrombosis, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 12/7/2010

VAERS ID: 363458 Before After
VAERS Form:
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) SANOFI) / SANOFI PASTEUR UP004AA / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Death, Dizziness, Fatigue, Obesity, Postnasal drip, Pulmonary embolism, Unresponsive to stimuli, Uterine leiomyoma, Weight decreased, Deep vein thrombosis, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 4/13/2011

VAERS ID: 363458 Before After
VAERS Form:
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) SANOFI) / SANOFI PASTEUR UP004AA / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Death, Dizziness, Fatigue, Obesity, Postnasal drip, Pulmonary embolism, Unresponsive to stimuli, Uterine leiomyoma, Weight decreased, Deep vein thrombosis, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 5/13/2011

VAERS ID: 363458 Before After
VAERS Form:
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) SANOFI) / SANOFI PASTEUR UP004AA / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Death, Dizziness, Fatigue, Obesity, Postnasal drip, Pulmonary embolism, Unresponsive to stimuli, Uterine leiomyoma, Weight decreased, Deep vein thrombosis, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 6/11/2011

VAERS ID: 363458 Before After
VAERS Form:
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) SANOFI) / SANOFI PASTEUR UP004AA / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Death, Dizziness, Fatigue, Obesity, Postnasal drip, Pulmonary embolism, Unresponsive to stimuli, Uterine leiomyoma, Weight decreased, Deep vein thrombosis, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 11/13/2012

VAERS ID: 363458 Before After
VAERS Form:
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) SANOFI) INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI) / SANOFI PASTEUR UP004AA / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Death, Dizziness, Fatigue, Obesity, Postnasal drip, Pulmonary embolism, Unresponsive to stimuli, Uterine leiomyoma, Weight decreased, Deep vein thrombosis, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 2/13/2013

VAERS ID: 363458 Before After
VAERS Form:
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI) / SANOFI PASTEUR UP004AA / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Death, Dizziness, Fatigue, Obesity, Postnasal drip, Pulmonary embolism, Unresponsive to stimuli, Uterine leiomyoma, Weight decreased, Deep vein thrombosis, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting. (245 vs. 246 characters long)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 6/14/2014

VAERS ID: 363458 Before After
VAERS Form:
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI) / SANOFI PASTEUR UP004AA / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Death, Dizziness, Fatigue, Obesity, Postnasal drip, Pulmonary embolism, Unresponsive to stimuli, Uterine leiomyoma, Weight decreased, Deep vein thrombosis, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 3/14/2015

VAERS ID: 363458 Before After
VAERS Form:
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI) / SANOFI PASTEUR UP004AA / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Death, Dizziness, Fatigue, Obesity, Postnasal drip, Pulmonary embolism, Unresponsive to stimuli, Uterine leiomyoma, Weight decreased, Deep vein thrombosis, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 2/14/2017

VAERS ID: 363458 Before After
VAERS Form:
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI) INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP004AA / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Death, Dizziness, Fatigue, Obesity, Postnasal drip, Pulmonary embolism, Unresponsive to stimuli, Uterine leiomyoma, Weight decreased, Deep vein thrombosis, Oropharyngeal pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 9/14/2017

VAERS ID: 363458 Before After
VAERS Form:(blank) 1
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP004AA / 0 1 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Death, Dizziness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 2/14/2018

VAERS ID: 363458 Before After
VAERS Form:1
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP004AA / 1 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Death, Dizziness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 6/14/2018

VAERS ID: 363458 Before After
VAERS Form:1
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP004AA / 1 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Death, Dizziness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 8/14/2018

VAERS ID: 363458 Before After
VAERS Form:1
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP004AA / 1 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Death, Dizziness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 9/14/2018

VAERS ID: 363458 Before After
VAERS Form:1
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP004AA / 1 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Death, Dizziness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.


Changed on 10/14/2018

VAERS ID: 363458 Before After
VAERS Form:1
Age:46.0
Gender:Female
Location:Florida
Vaccinated:2009-10-26
Onset:2009-10-27
Submitted:2009-10-28
Entered:2009-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP004AA / 1 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Death, Dizziness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-28
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: Metoprolol 50mg BID; HYZAAR 100mg/25mg QD; ASA 81 mg chew 1 QAM
Current Illness:
Preexisting Conditions: Obesity; Hypertension; Hyperlipidemia etc. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 Hypertension, hyperlipidemia, pulmonary embolism, impaired fasting glucose, obesity, DVT, hydradenitis supurative, skin grafting.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client contacted Dr.''s office on 10/27/09 approximately equal to 0900 c/o feeling lightheaded and was not sure whether it was due to low BP or having received an H1N1 injection the day prior (10/26/09). Position: ESE Paraprofessional (worked with special needs children). An autopsy will be performed. 10/29/09 PCP medical records received service dates 10/26/09 to 10/28/09 includes vaccine records. Assessment: URI, low blood pressure, fatigue. On 10/27/09 Patient presents with low blood pressure and fatigue. Slight sore throat and post nasal drainage. Weak, ''woozy''. Weight loss of 38 lbs since 2/08. On 10/28/09 notified that patient had expired. 12/28/09 Note from Medical Examiner. DOD 10/28/09. Patient found unresponsive in bed at home. History of recurring deep vein thrombosis. Autopsy results show saddle embolus resulting in death. Local Health Department requested this office''s assistance in regards to possible infection with H1N1. 1/5/09 Autopsy Report received. DOD 10/28/09. Final Cause of Death: Pulmonary Thromboembolism Due To Recurrent Lower Extremity Deep Vein Thrombosis. Additional Information Abstracted: Contributing - Morbid Obesity, Uterine Leiomyomata.

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