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This is VAERS ID 604128

History of Changes from the VAERS Wayback Machine

First Appeared on 11/14/2015

VAERS ID: 604128
VAERS Form:
Age:60.0
Gender:Female
Location:Vermont
Vaccinated:2015-10-19
Onset:2015-10-20
Submitted:2015-10-21
Entered:2015-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / UN
VARZOS: ZOSTER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site reaction, Local reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Local reaction - zoster vaccine (R) deltoid. Recommended Topical hydrocortisone.


Changed on 12/14/2016

VAERS ID: 604128 Before After
VAERS Form:
Age:60.0
Gender:Female
Location:Vermont
Vaccinated:2015-10-19
Onset:2015-10-20
Submitted:2015-10-21
Entered:2015-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / UN
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LA / UN
VARZOS: ZOSTER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site reaction, Local reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Local reaction - zoster vaccine (R) deltoid. Recommended Topical hydrocortisone.


Changed on 9/14/2017

VAERS ID: 604128 Before After
VAERS Form:(blank) 1
Age:60.0
Gender:Female
Location:Vermont
Vaccinated:2015-10-19
Onset:2015-10-20
Submitted:2015-10-21
Entered:2015-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK LA / UN
VARZOS: ZOSTER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK RA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site reaction, Local reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Local reaction - zoster vaccine (R) deltoid. Recommended Topical hydrocortisone.


Changed on 2/14/2018

VAERS ID: 604128 Before After
VAERS Form:1
Age:60.0
Gender:Female
Location:Vermont
Vaccinated:2015-10-19
Onset:2015-10-20
Submitted:2015-10-21
Entered:2015-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / UN
VARZOS: ZOSTER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site reaction, Local reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Local reaction - zoster vaccine (R) deltoid. Recommended Topical hydrocortisone.


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