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This is VAERS ID 58319

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58319
VAERS Form:
Age:80.1
Sex:Female
Location:Missouri
Vaccinated:1993-10-22
Onset:1993-11-26
Submitted:1993-12-11
Entered:1993-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1993-1994 / PARKE-DAVIS 00863P / - RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: LIVER FAIL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: acute hepatocellular failure;


Changed on 12/8/2009

VAERS ID: 58319 Before After
VAERS Form:
Age:80.1
Sex:Female
Location:Missouri
Vaccinated:1993-10-22
Onset:1993-11-26
Submitted:1993-12-11
Entered:1993-12-23 1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1993-1994 INFLUENZA (SEASONAL) (FLUOGEN 93-94) / PARKE-DAVIS 00863P / - RA / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Hepatic failure, LIVER FAIL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: acute hepatocellular failure;


Changed on 8/31/2010

VAERS ID: 58319 Before After
VAERS Form:
Age:80.1
Sex:Female
Location:Missouri
Vaccinated:1993-10-22
Onset:1993-11-26
Submitted:1993-12-11
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 93-94) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / - RA / -

Administered by: Private      Purchased by: Other
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: acute hepatocellular failure;


Changed on 7/7/2013

VAERS ID: 58319 Before After
VAERS Form:
Age:80.1
Sex:Female
Location:Missouri
Vaccinated:1993-10-22
Onset:1993-11-26
Submitted:1993-12-11
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / - RA / -
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / - RA / -

Administered by: Private      Purchased by: Other
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: acute hepatocellular failure;


Changed on 2/14/2017

VAERS ID: 58319 Before After
VAERS Form:
Age:80.1 80.0
Sex:Female
Location:Missouri
Vaccinated:1993-10-22
Onset:1993-11-26
Submitted:1993-12-11
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / - RA / -

Administered by: Private      Purchased by: Other
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: acute hepatocellular failure;


Changed on 5/14/2017

VAERS ID: 58319 Before After
VAERS Form:
Age:80.0
Sex:Female
Location:Missouri
Vaccinated:1993-10-22
Onset:1993-11-26
Submitted:1993-12-11
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / - RA / -

Administered by: Private      Purchased by: Other
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: acute hepatocellular failure;


Changed on 9/14/2017

VAERS ID: 58319 Before After
VAERS Form:(blank) 1
Age:80.0
Sex:Female
Location:Missouri
Vaccinated:1993-10-22
Onset:1993-11-26
Submitted:1993-12-11
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / - UNK RA / -

Administered by: Private      Purchased by: Other
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: acute hepatocellular failure;


Changed on 2/14/2018

VAERS ID: 58319 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:Missouri
Vaccinated:1993-10-22
Onset:1993-11-26
Submitted:1993-12-11
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK RA / -

Administered by: Private      Purchased by: Other
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: acute hepatocellular failure;


Changed on 6/14/2018

VAERS ID: 58319 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:Missouri
Vaccinated:1993-10-22
Onset:1993-11-26
Submitted:1993-12-11
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK RA / -

Administered by: Private      Purchased by: Other
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: acute hepatocellular failure;


Changed on 8/14/2018

VAERS ID: 58319 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:Missouri
Vaccinated:1993-10-22
Onset:1993-11-26
Submitted:1993-12-11
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK RA / -

Administered by: Private      Purchased by: Other
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: acute hepatocellular failure;


Changed on 9/14/2018

VAERS ID: 58319 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:Missouri
Vaccinated:1993-10-22
Onset:1993-11-26
Submitted:1993-12-11
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK RA / -

Administered by: Private      Purchased by: Other
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: acute hepatocellular failure;


Changed on 10/14/2018

VAERS ID: 58319 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:Missouri
Vaccinated:1993-10-22
Onset:1993-11-26
Submitted:1993-12-11
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK RA / -

Administered by: Private      Purchased by: Other
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: ~ ()~~~In patient
Other Medications: Capoten, HCTZ, K-tab, Quinine Sulfate;
Current Illness: hypertonia;
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: acute hepatocellular failure;

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