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This is VAERS ID 105125

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 105125
VAERS Form:
Age:101
Sex:Female
Location:New York
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-17
Entered:1997-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1997-1998 / CONNAUGHT LABS 7F81916 / 0 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: CHILLS, FEVER, DYSPNEA, PALLOR, SPUTUM INC

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-30
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:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


Changed on 12/8/2009

VAERS ID: 105125 Before After
VAERS Form:
Age:101 (blank)
Sex:Female
Location:New York
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-17
Entered:1997-11-26 1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1997-1998 INFLUENZA (SEASONAL) (FLUZONE 97-98) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7F81916 / 0 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor, CHILLS, FEVER, DYSPNEA, PALLOR, SPUTUM INC

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-30
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:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


Changed on 8/31/2010

VAERS ID: 105125 Before After
VAERS Form:
Age:
Sex:Female
Location:New York
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-17
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 97-98) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 0 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-30
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:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


Changed on 7/7/2013

VAERS ID: 105125 Before After
VAERS Form:
Age:
Sex:Female
Location:New York
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-17
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 0 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 0 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-30
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:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


Changed on 2/14/2017

VAERS ID: 105125 Before After
VAERS Form:
Age:(blank) 100.0
Sex:Female
Location:New York
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-17
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 0 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-30
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:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


Changed on 5/14/2017

VAERS ID: 105125 Before After
VAERS Form:
Age:100.0
Sex:Female
Location:New York
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-17
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 0 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


Changed on 9/14/2017

VAERS ID: 105125 Before After
VAERS Form:(blank) 1
Age:100.0
Sex:Female
Location:New York
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-17
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 0 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


Changed on 2/14/2018

VAERS ID: 105125 Before After
VAERS Form:1
Age:100.0
Sex:Female
Location:New York
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-17
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


Changed on 6/14/2018

VAERS ID: 105125 Before After
VAERS Form:1
Age:100.0
Sex:Female
Location:New York
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-17
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


Changed on 8/14/2018

VAERS ID: 105125 Before After
VAERS Form:1
Age:100.0
Sex:Female
Location:New York
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-17
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


Changed on 9/14/2018

VAERS ID: 105125 Before After
VAERS Form:1
Age:100.0
Sex:Female
Location:New York
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-17
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;


Changed on 10/14/2018

VAERS ID: 105125 Before After
VAERS Form:1
Age:100.0
Sex:Female
Location:New York
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-17
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81916 / 1 - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chills, Dyspnoea, Pallor, Productive cough, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: no allergies-had degenerative osteoarthritis cerebrovascular insufficiency
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 27OCT97 & w/in a few hr T103.3, chills, shaking, inc temp cont for 2 days on 29OCT:T106.3 color pale blowing resp exp green sputum transferred to hosp;

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=105125&WAYBACKHISTORY=ON


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