National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 513554

History of Changes from the VAERS Wayback Machine

First Appeared on 12/13/2013

VAERS ID: 513554
VAERS Form:
Age:14.0
Sex:Female
Location:Minnesota
Vaccinated:2012-08-01
Onset:0000-00-00
Submitted:2013-11-15
Entered:2013-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death, Dyspnoea, Influenza, Pulmonary oedema, Pyrexia, Wheezing, Cardiopulmonary bypass, Transfusion, Oropharyngeal pain

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2013-01-08
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': 2013SA114788

Write-up: Initial report was received on 07 November 2013 from a nonhealth care provider from an unverified internet source. A 14 year-old female patient (date of birth not reported) had received on an unspecified date in August 2012 a Influenza vaccine (manufacturer, lot number, route, site and date of administration not reported) and five months later on 08 January 2013 "died from complications of infection with Influenza Type A". The patient was evaluated at and urgent care with a bad sore throat, treated with Prednisone and was sent home. The sore throat evolved into a serious fever that included shortness of breath and wheezing. The patient''s lungs filled with fluid and was hospitalized. The patient had a heart and lung bypass with an "ACMO" machine and blood transfusions. Diagnostic and laboratory testing were not reported. The patient''s outcome was fatal. Documents held by sender: none.


Changed on 3/14/2014

VAERS ID: 513554 Before After
VAERS Form:
Age:14.0
Sex:Female
Location:Minnesota
Vaccinated:2012-08-01 2012-08-31
Onset:0000-00-00 2012-12-20
Submitted:2013-11-15
Entered:2013-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2024 / 4 - / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H010649 / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Dyspnoea, Influenza, Pulmonary oedema, Pyrexia, Wheezing, Cardiopulmonary bypass, Transfusion, Oropharyngeal pain

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2013-01-08
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: (blank) 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': 2013SA114788

Write-up: Initial report was received on 07 November 2013 from a nonhealth care provider from an unverified internet source. A 14 year-old female patient (date of birth not reported) had received on an unspecified date in August 2012 a Influenza vaccine (manufacturer, lot number, route, site and date of administration not reported) and five months later on 08 January 2013 "died from complications of infection with Influenza Type A". The patient was evaluated at and urgent care with a bad sore throat, treated with Prednisone and was sent home. The sore throat evolved into a serious fever that included shortness of breath and wheezing. The patient''s lungs filled with fluid and was hospitalized. The patient had a heart and lung bypass with an "ACMO" machine and blood transfusions. Diagnostic and laboratory testing were not reported. The patient''s outcome was fatal. Documents held by sender: none.


Changed on 6/14/2014

VAERS ID: 513554 Before After
VAERS Form:
Age:14.0
Sex:Female
Location:Minnesota
Vaccinated:2012-08-31
Onset:2012-12-20
Submitted:2013-11-15
Entered:2013-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2024 / 4 - / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H010649 / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Dyspnoea, Influenza, Pulmonary oedema, Pyrexia, Wheezing, Cardiopulmonary bypass, Transfusion, Oropharyngeal pain

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2013-01-08
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: 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': 2013SA114788

Write-up: Initial report was received on 07 November 2013 from a nonhealth care provider from an unverified internet source. A 14 year-old female patient (date of birth not reported) had received on an unspecified date in August 2012 a Influenza vaccine (manufacturer, lot number, route, site and date of administration not reported) and five months later on 08 January 2013 "died from complications of infection with Influenza Type A". The patient was evaluated at and urgent care with a bad sore throat, treated with Prednisone and was sent home. The sore throat evolved into a serious fever that included shortness of breath and wheezing. The patient''s lungs filled with fluid and was hospitalized. The patient had a heart and lung bypass with an "ACMO" machine and blood transfusions. Diagnostic and laboratory testing were not reported. The patient''s outcome was fatal. Documents held by sender: none.


Changed on 3/14/2015

VAERS ID: 513554 Before After
VAERS Form:
Age:14.0
Sex:Female
Location:Minnesota
Vaccinated:2012-08-31
Onset:2012-12-20
Submitted:2013-11-15
Entered:2013-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2024 / 4 - / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H010649 / 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Dyspnoea, Influenza, Pulmonary oedema, Pyrexia, Wheezing, Cardiopulmonary bypass, Transfusion, Oropharyngeal pain

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2013-01-08
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: 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': 2013SA114788

Write-up: Initial report was received on 07 November 2013 from a nonhealth care provider from an unverified internet source. A 14 year-old female patient (date of birth not reported) had received on an unspecified date in August 2012 a Influenza vaccine (manufacturer, lot number, route, site and date of administration not reported) and five months later on 08 January 2013 "died from complications of infection with Influenza Type A". The patient was evaluated at and urgent care with a bad sore throat, treated with Prednisone and was sent home. The sore throat evolved into a serious fever that included shortness of breath and wheezing. The patient''s lungs filled with fluid and was hospitalized. The patient had a heart and lung bypass with an "ACMO" machine and blood transfusions. Diagnostic and laboratory testing were not reported. The patient''s outcome was fatal. Documents held by sender: none.


Changed on 9/14/2017

VAERS ID: 513554 Before After
VAERS Form:(blank) 1
Age:14.0
Sex:Female
Location:Minnesota
Vaccinated:2012-08-31
Onset:2012-12-20
Submitted:2013-11-15
Entered:2013-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2024 / 4 5 - NS / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H010649 / 1 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Dyspnoea, Influenza, Pulmonary oedema, Pyrexia, Wheezing, Cardiopulmonary bypass, Transfusion, Oropharyngeal pain

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2013-01-08
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: 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': 2013SA114788

Write-up: Initial report was received on 07 November 2013 from a nonhealth care provider from an unverified internet source. A 14 year-old female patient (date of birth not reported) had received on an unspecified date in August 2012 a Influenza vaccine (manufacturer, lot number, route, site and date of administration not reported) and five months later on 08 January 2013 "died from complications of infection with Influenza Type A". The patient was evaluated at and urgent care with a bad sore throat, treated with Prednisone and was sent home. The sore throat evolved into a serious fever that included shortness of breath and wheezing. The patient''s lungs filled with fluid and was hospitalized. The patient had a heart and lung bypass with an "ACMO" machine and blood transfusions. Diagnostic and laboratory testing were not reported. The patient''s outcome was fatal. Documents held by sender: none.


Changed on 2/14/2018

VAERS ID: 513554 Before After
VAERS Form:1
Age:14.0
Sex:Female
Location:Minnesota
Vaccinated:2012-08-31
Onset:2012-12-20
Submitted:2013-11-15
Entered:2013-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2024 / 5 NS / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H010649 / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Dyspnoea, Influenza, Pulmonary oedema, Pyrexia, Wheezing, Cardiopulmonary bypass, Transfusion, Oropharyngeal pain

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2013-01-08
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: 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': 2013SA114788

Write-up: Initial report was received on 07 November 2013 from a nonhealth care provider from an unverified internet source. A 14 year-old female patient (date of birth not reported) had received on an unspecified date in August 2012 a Influenza vaccine (manufacturer, lot number, route, site and date of administration not reported) and five months later on 08 January 2013 "died from complications of infection with Influenza Type A". The patient was evaluated at and urgent care with a bad sore throat, treated with Prednisone and was sent home. The sore throat evolved into a serious fever that included shortness of breath and wheezing. The patient''s lungs filled with fluid and was hospitalized. The patient had a heart and lung bypass with an "ACMO" machine and blood transfusions. Diagnostic and laboratory testing were not reported. The patient''s outcome was fatal. Documents held by sender: none.


Changed on 6/14/2018

VAERS ID: 513554 Before After
VAERS Form:1
Age:14.0
Sex:Female
Location:Minnesota
Vaccinated:2012-08-31
Onset:2012-12-20
Submitted:2013-11-15
Entered:2013-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2024 / 5 NS / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H010649 / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Dyspnoea, Influenza, Pulmonary oedema, Pyrexia, Wheezing, Cardiopulmonary bypass, Transfusion, Oropharyngeal pain

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2013-01-08
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: 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': 2013SA114788

Write-up: Initial report was received on 07 November 2013 from a nonhealth care provider from an unverified internet source. A 14 year-old female patient (date of birth not reported) had received on an unspecified date in August 2012 a Influenza vaccine (manufacturer, lot number, route, site and date of administration not reported) and five months later on 08 January 2013 "died from complications of infection with Influenza Type A". The patient was evaluated at and urgent care with a bad sore throat, treated with Prednisone and was sent home. The sore throat evolved into a serious fever that included shortness of breath and wheezing. The patient''s lungs filled with fluid and was hospitalized. The patient had a heart and lung bypass with an "ACMO" machine and blood transfusions. Diagnostic and laboratory testing were not reported. The patient''s outcome was fatal. Documents held by sender: none.


Changed on 8/14/2018

VAERS ID: 513554 Before After
VAERS Form:1
Age:14.0
Sex:Female
Location:Minnesota
Vaccinated:2012-08-31
Onset:2012-12-20
Submitted:2013-11-15
Entered:2013-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2024 / 5 NS / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H010649 / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Dyspnoea, Influenza, Pulmonary oedema, Pyrexia, Wheezing, Cardiopulmonary bypass, Transfusion, Oropharyngeal pain

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2013-01-08
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: 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': 2013SA114788

Write-up: Initial report was received on 07 November 2013 from a nonhealth care provider from an unverified internet source. A 14 year-old female patient (date of birth not reported) had received on an unspecified date in August 2012 a Influenza vaccine (manufacturer, lot number, route, site and date of administration not reported) and five months later on 08 January 2013 "died from complications of infection with Influenza Type A". The patient was evaluated at and urgent care with a bad sore throat, treated with Prednisone and was sent home. The sore throat evolved into a serious fever that included shortness of breath and wheezing. The patient''s lungs filled with fluid and was hospitalized. The patient had a heart and lung bypass with an "ACMO" machine and blood transfusions. Diagnostic and laboratory testing were not reported. The patient''s outcome was fatal. Documents held by sender: none.


Changed on 9/14/2018

VAERS ID: 513554 Before After
VAERS Form:1
Age:14.0
Sex:Female
Location:Minnesota
Vaccinated:2012-08-31
Onset:2012-12-20
Submitted:2013-11-15
Entered:2013-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2024 / 5 NS / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H010649 / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Dyspnoea, Influenza, Pulmonary oedema, Pyrexia, Wheezing, Cardiopulmonary bypass, Transfusion, Oropharyngeal pain

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2013-01-08
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: 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': 2013SA114788

Write-up: Initial report was received on 07 November 2013 from a nonhealth care provider from an unverified internet source. A 14 year-old female patient (date of birth not reported) had received on an unspecified date in August 2012 a Influenza vaccine (manufacturer, lot number, route, site and date of administration not reported) and five months later on 08 January 2013 "died from complications of infection with Influenza Type A". The patient was evaluated at and urgent care with a bad sore throat, treated with Prednisone and was sent home. The sore throat evolved into a serious fever that included shortness of breath and wheezing. The patient''s lungs filled with fluid and was hospitalized. The patient had a heart and lung bypass with an "ACMO" machine and blood transfusions. Diagnostic and laboratory testing were not reported. The patient''s outcome was fatal. Documents held by sender: none.


Changed on 10/14/2018

VAERS ID: 513554 Before After
VAERS Form:1
Age:14.0
Sex:Female
Location:Minnesota
Vaccinated:2012-08-31
Onset:2012-12-20
Submitted:2013-11-15
Entered:2013-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AJ2024 / 5 NS / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H010649 / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Death, Dyspnoea, Influenza, Pulmonary oedema, Pyrexia, Wheezing, Cardiopulmonary bypass, Transfusion, Oropharyngeal pain

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2013-01-08
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: 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': 2013SA114788

Write-up: Initial report was received on 07 November 2013 from a nonhealth care provider from an unverified internet source. A 14 year-old female patient (date of birth not reported) had received on an unspecified date in August 2012 a Influenza vaccine (manufacturer, lot number, route, site and date of administration not reported) and five months later on 08 January 2013 "died from complications of infection with Influenza Type A". The patient was evaluated at and urgent care with a bad sore throat, treated with Prednisone and was sent home. The sore throat evolved into a serious fever that included shortness of breath and wheezing. The patient''s lungs filled with fluid and was hospitalized. The patient had a heart and lung bypass with an "ACMO" machine and blood transfusions. Diagnostic and laboratory testing were not reported. The patient''s outcome was fatal. Documents held by sender: none.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=513554&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166