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This is VAERS ID 211782

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 211782
VAERS Form:
Age:47.0
Sex:Male
Location:Georgia
Vaccinated:2003-10-05
Onset:2003-10-07
Submitted:2003-11-04
Entered:2003-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX, ADSORBED (BIOTHRAX) / BIOPORT CORPORAT FAV075 / 0 - / IM
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR, UB233AA / 0 - / SC
SMALL: SMALLPOX (DRYVAX) / WYETH LABORATORI 4020071 / 1 - / LA
TYP: TYPHOID (TYPHIM VI) / AVENTIS PASTEUR, W1344 / 0 - / IM

Administered by: Military      Purchased by: Unknown
Symptoms: STUPOR, MALAISE, DYSPEPSIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-10-07
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: None known
Current Illness:
Preexisting Conditions: High blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%.
Allergies:
Diagnostic Lab Data: PPD skin test applied on 10/5/03
CDC 'Split Type':

Write-up: Soldier did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to barracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived,"patient was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood pressure; 15-year smoking history, new heart


Changed on 12/8/2009

VAERS ID: 211782 Before After
VAERS Form:
Age:47.0
Sex:Male
Location:Georgia
Vaccinated:2003-10-05
Onset:2003-10-07
Submitted:2003-11-04 2003-03-07
Entered:2003-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX, ADSORBED (BIOTHRAX) ANTHRAX (BIOTHRAX) / BIOPORT CORPORAT EMERGENT BIOSOLUTIONS FAV075 FAV078 / 0 - RA / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR, AVENTIS PASTEUR UB233AA / 0 - / SC
SMALL: SMALLPOX (DRYVAX) / WYETH LABORATORI WYETH PHARMACEUTICALS, INC 4020071 / 1 - LA / LA -
TYP: TYPHOID (TYPHIM VI) TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / AVENTIS PASTEUR, AVENTIS PASTEUR W1344 / 0 - / IM

Administered by: Military Unknown      Purchased by: Unknown
Symptoms: Arteriosclerosis, Cardiovascular disorder, Coma, Coronary artery occlusion, Malaise, Stomach discomfort, STUPOR, MALAISE, DYSPEPSIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-10-07
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: None known Deconamine SR
Current Illness: FEVER
Preexisting Conditions: High blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Diagnosed wit URI on 9/30/03 and treated with Deconamine SR BID x 10d.
Allergies:
Diagnostic Lab Data: PPD skin test applied on 10/5/03
CDC 'Split Type':

Write-up: Soldier Patient did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to barracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived,"patient arrived, patient was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Add''l medical records will be provided once available. Pt did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to baracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, pt was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood presure; 15-year smoking history, new heart murmur 1/6 systolic. Diagnosed with URI on 09/30/2003 and treated with Deconamine SR BIDx 10d. Preliminary autopsy findings: ASCVD with left main coronary artery occluded 90%, left anterior descending cornonary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Nurse follow up on 11/08/04 states: "Severe Atherosclerotic Cardiovascular Disease."


Changed on 8/31/2010

VAERS ID: 211782 Before After
VAERS Form:
Age:47.0
Sex:Male
Location:Georgia
Vaccinated:2003-10-05
Onset:2003-10-07
Submitted:2003-03-07
Entered:2003-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV078 / 0 RA / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR UB233AA / 0 - / SC
SMALL: SMALLPOX (DRYVAX) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4020071 / 1 LA / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / AVENTIS PASTEUR W1344 / 0 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arteriosclerosis, Cardiovascular disorder, Coma, Coronary artery occlusion, Malaise, Stomach discomfort

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-10-07
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: Deconamine SR
Current Illness: FEVER
Preexisting Conditions: High blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Diagnosed wit URI on 9/30/03 and treated with Deconamine SR BID x 10d.
Allergies:
Diagnostic Lab Data: PPD skin test applied on 10/5/03
CDC 'Split Type':

Write-up: Patient did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to barracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, patient was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Add''l medical records will be provided once available. Pt did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to baracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, pt was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood presure; 15-year smoking history, new heart murmur 1/6 systolic. Diagnosed with URI on 09/30/2003 and treated with Deconamine SR BIDx 10d. Preliminary autopsy findings: ASCVD with left main coronary artery occluded 90%, left anterior descending cornonary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Nurse follow up on 11/08/04 states: "Severe Atherosclerotic Cardiovascular Disease."


Changed on 5/12/2012

VAERS ID: 211782 Before After
VAERS Form:
Age:47.0
Sex:Male
Location:Georgia
Vaccinated:2003-10-05
Onset:2003-10-07
Submitted:2003-03-07
Entered:2003-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV078 / 0 RA / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR SANOFI PASTEUR UB233AA / 0 - / SC
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 LA / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / AVENTIS PASTEUR SANOFI PASTEUR W1344 / 0 - / IM

Administered by: Unknown Military      Purchased by: Unknown Military
Symptoms: Arteriosclerosis, Cardiovascular disorder, Coma, Coronary artery occlusion, Malaise, Stomach discomfort

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-10-07
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: Deconamine SR
Current Illness: FEVER
Preexisting Conditions: High blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Diagnosed wit URI on 9/30/03 and treated with Deconamine SR BID x 10d.
Allergies:
Diagnostic Lab Data: PPD skin test applied on 10/5/03
CDC 'Split Type':

Write-up: Patient did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to barracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, patient was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Add''l medical records will be provided once available. Pt did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to baracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, pt was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood presure; 15-year smoking history, new heart murmur 1/6 systolic. Diagnosed with URI on 09/30/2003 and treated with Deconamine SR BIDx 10d. Preliminary autopsy findings: ASCVD with left main coronary artery occluded 90%, left anterior descending cornonary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Nurse follow up on 11/08/04 states: "Severe Atherosclerotic Cardiovascular Disease."


Changed on 6/14/2014

VAERS ID: 211782 Before After
VAERS Form:
Age:47.0
Sex:Male
Location:Georgia
Vaccinated:2003-10-05
Onset:2003-10-07
Submitted:2003-03-07
Entered:2003-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV078 / 0 RA / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB233AA / 0 - / SC
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 LA / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR W1344 / 0 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Arteriosclerosis, Cardiovascular disorder, Coma, Coronary artery occlusion, Malaise, Stomach discomfort

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-10-07
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: Deconamine SR
Current Illness: FEVER
Preexisting Conditions: High blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Diagnosed wit URI on 9/30/03 and treated with Deconamine SR BID x 10d.
Allergies:
Diagnostic Lab Data: PPD skin test applied on 10/5/03
CDC 'Split Type':

Write-up: Patient did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to barracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, patient was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Add''l medical records will be provided once available. Pt did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to baracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, pt was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood presure; 15-year smoking history, new heart murmur 1/6 systolic. Diagnosed with URI on 09/30/2003 and treated with Deconamine SR BIDx 10d. Preliminary autopsy findings: ASCVD with left main coronary artery occluded 90%, left anterior descending cornonary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Nurse follow up on 11/08/04 states: "Severe Atherosclerotic Cardiovascular Disease."


Changed on 5/14/2017

VAERS ID: 211782 Before After
VAERS Form:
Age:47.0
Sex:Male
Location:Georgia
Vaccinated:2003-10-05
Onset:2003-10-07
Submitted:2003-03-07
Entered:2003-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV078 / 0 RA / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB233AA / 0 - / SC
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 LA / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR W1344 / 0 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Arteriosclerosis, Cardiovascular disorder, Coma, Coronary artery occlusion, Malaise, Stomach discomfort

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-10-07
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: Deconamine SR
Current Illness: FEVER
Preexisting Conditions: High blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Diagnosed wit URI on 9/30/03 and treated with Deconamine SR BID x 10d.
Allergies:
Diagnostic Lab Data: PPD skin test applied on 10/5/03
CDC 'Split Type':

Write-up: Patient did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to barracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, patient was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Add''l medical records will be provided once available. Pt did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to baracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, pt was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood presure; 15-year smoking history, new heart murmur 1/6 systolic. Diagnosed with URI on 09/30/2003 and treated with Deconamine SR BIDx 10d. Preliminary autopsy findings: ASCVD with left main coronary artery occluded 90%, left anterior descending cornonary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Nurse follow up on 11/08/04 states: "Severe Atherosclerotic Cardiovascular Disease."


Changed on 9/14/2017

VAERS ID: 211782 Before After
VAERS Form:(blank) 1
Age:47.0
Sex:Male
Location:Georgia
Vaccinated:2003-10-05
Onset:2003-10-07
Submitted:2003-03-07
Entered:2003-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV078 / 0 1 RA / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 2 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB233AA / 0 1 - / SC
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 2 LA / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR W1344 / 0 1 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Arteriosclerosis, Cardiovascular disorder, Coma, Coronary artery occlusion, Malaise, Stomach discomfort

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-10-07
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: Deconamine SR
Current Illness: FEVER
Preexisting Conditions: High blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Diagnosed wit URI on 9/30/03 and treated with Deconamine SR BID x 10d.
Allergies:
Diagnostic Lab Data: PPD skin test applied on 10/5/03
CDC 'Split Type':

Write-up: Patient did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to barracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, patient was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Add''l medical records will be provided once available. Pt did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to baracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, pt was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood presure; 15-year smoking history, new heart murmur 1/6 systolic. Diagnosed with URI on 09/30/2003 and treated with Deconamine SR BIDx 10d. Preliminary autopsy findings: ASCVD with left main coronary artery occluded 90%, left anterior descending cornonary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Nurse follow up on 11/08/04 states: "Severe Atherosclerotic Cardiovascular Disease."


Changed on 2/14/2018

VAERS ID: 211782 Before After
VAERS Form:1
Age:47.0
Sex:Male
Location:Georgia
Vaccinated:2003-10-05
Onset:2003-10-07
Submitted:2003-03-07
Entered:2003-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV078 / 1 RA / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB233AA / 1 - / SC
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 2 LA / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR W1344 / 1 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Arteriosclerosis, Cardiovascular disorder, Coma, Coronary artery occlusion, Malaise, Stomach discomfort

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-10-07
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: Deconamine SR
Current Illness: FEVER
Preexisting Conditions: High blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Diagnosed wit URI on 9/30/03 and treated with Deconamine SR BID x 10d.
Allergies:
Diagnostic Lab Data: PPD skin test applied on 10/5/03
CDC 'Split Type':

Write-up: Patient did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to barracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, patient was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Add''l medical records will be provided once available. Pt did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to baracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, pt was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood presure; 15-year smoking history, new heart murmur 1/6 systolic. Diagnosed with URI on 09/30/2003 and treated with Deconamine SR BIDx 10d. Preliminary autopsy findings: ASCVD with left main coronary artery occluded 90%, left anterior descending cornonary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Nurse follow up on 11/08/04 states: "Severe Atherosclerotic Cardiovascular Disease."


Changed on 6/14/2018

VAERS ID: 211782 Before After
VAERS Form:1
Age:47.0
Sex:Male
Location:Georgia
Vaccinated:2003-10-05
Onset:2003-10-07
Submitted:2003-03-07
Entered:2003-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV078 / 1 RA / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB233AA / 1 - / SC
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 2 LA / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR W1344 / 1 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Arteriosclerosis, Cardiovascular disorder, Coma, Coronary artery occlusion, Malaise, Stomach discomfort

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-10-07
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: Deconamine SR
Current Illness: FEVER
Preexisting Conditions: High blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Diagnosed wit URI on 9/30/03 and treated with Deconamine SR BID x 10d.
Allergies:
Diagnostic Lab Data: PPD skin test applied on 10/5/03
CDC 'Split Type':

Write-up: Patient did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to barracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, patient was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Add''l medical records will be provided once available. Pt did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to baracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, pt was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood presure; 15-year smoking history, new heart murmur 1/6 systolic. Diagnosed with URI on 09/30/2003 and treated with Deconamine SR BIDx 10d. Preliminary autopsy findings: ASCVD with left main coronary artery occluded 90%, left anterior descending cornonary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Nurse follow up on 11/08/04 states: "Severe Atherosclerotic Cardiovascular Disease."


Changed on 8/14/2018

VAERS ID: 211782 Before After
VAERS Form:1
Age:47.0
Sex:Male
Location:Georgia
Vaccinated:2003-10-05
Onset:2003-10-07
Submitted:2003-03-07
Entered:2003-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV078 / 1 RA / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB233AA / 1 - / SC
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 2 LA / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR W1344 / 1 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Arteriosclerosis, Cardiovascular disorder, Coma, Coronary artery occlusion, Malaise, Stomach discomfort

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-10-07
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: Deconamine SR
Current Illness: FEVER
Preexisting Conditions: High blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Diagnosed wit URI on 9/30/03 and treated with Deconamine SR BID x 10d.
Allergies:
Diagnostic Lab Data: PPD skin test applied on 10/5/03
CDC 'Split Type':

Write-up: Patient did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to barracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, patient was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Add''l medical records will be provided once available. Pt did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to baracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, pt was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood presure; 15-year smoking history, new heart murmur 1/6 systolic. Diagnosed with URI on 09/30/2003 and treated with Deconamine SR BIDx 10d. Preliminary autopsy findings: ASCVD with left main coronary artery occluded 90%, left anterior descending cornonary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Nurse follow up on 11/08/04 states: "Severe Atherosclerotic Cardiovascular Disease."


Changed on 9/14/2018

VAERS ID: 211782 Before After
VAERS Form:1
Age:47.0
Sex:Male
Location:Georgia
Vaccinated:2003-10-05
Onset:2003-10-07
Submitted:2003-03-07
Entered:2003-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV078 / 1 RA / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB233AA / 1 - / SC
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 2 LA / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR W1344 / 1 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Arteriosclerosis, Cardiovascular disorder, Coma, Coronary artery occlusion, Malaise, Stomach discomfort

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-10-07
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: Deconamine SR
Current Illness: FEVER
Preexisting Conditions: High blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Diagnosed wit URI on 9/30/03 and treated with Deconamine SR BID x 10d.
Allergies:
Diagnostic Lab Data: PPD skin test applied on 10/5/03
CDC 'Split Type':

Write-up: Patient did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to barracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, patient was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Add''l medical records will be provided once available. Pt did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to baracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, pt was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood presure; 15-year smoking history, new heart murmur 1/6 systolic. Diagnosed with URI on 09/30/2003 and treated with Deconamine SR BIDx 10d. Preliminary autopsy findings: ASCVD with left main coronary artery occluded 90%, left anterior descending cornonary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Nurse follow up on 11/08/04 states: "Severe Atherosclerotic Cardiovascular Disease."


Changed on 10/14/2018

VAERS ID: 211782 Before After
VAERS Form:1
Age:47.0
Sex:Male
Location:Georgia
Vaccinated:2003-10-05
Onset:2003-10-07
Submitted:2003-03-07
Entered:2003-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV078 / 1 RA / IM
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB233AA / 1 - / SC
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 2 LA / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR W1344 / 1 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Arteriosclerosis, Cardiovascular disorder, Coma, Coronary artery occlusion, Malaise, Stomach discomfort

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-10-07
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: Deconamine SR
Current Illness: FEVER
Preexisting Conditions: High blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Diagnosed wit URI on 9/30/03 and treated with Deconamine SR BID x 10d.
Allergies:
Diagnostic Lab Data: PPD skin test applied on 10/5/03
CDC 'Split Type':

Write-up: Patient did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to barracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, patient was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood pressure; 15-year smoking history, new heart murmur 1/6 systolic. Preliminary autopsy findings: ASCVD w/ left main coronary artery occluded 90%, left anterior descending coronary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Add''l medical records will be provided once available. Pt did vigorous physical training session just before dinner, went to dinner, didn''t feel well (upset stomach), went to baracks, apparently fell out of top bunk, was unresponsive. CPR started promptly with physician assistant attending. EMS arrived, pt was in asystole with no response to ACLS protocols. Transported to ER and ACLS continued with no response. Post-mortem x-ray showed no skeletal fracture or dislocation. Well known to unit PA; high blood presure; 15-year smoking history, new heart murmur 1/6 systolic. Diagnosed with URI on 09/30/2003 and treated with Deconamine SR BIDx 10d. Preliminary autopsy findings: ASCVD with left main coronary artery occluded 90%, left anterior descending cornonary artery occluded 85%. Final autopsy report awaits tissue and toxicology findings. Nurse follow up on 11/08/04 states: "Severe Atherosclerotic Cardiovascular Disease."

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