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This is VAERS ID 105612

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 105612
VAERS Form:
Age:52.2
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1997-1998 / MEDEVA PHARMS LI - / - RA / -

Administered by: Other      Purchased by: Unknown
Symptoms: DIZZINESS, NAUSEA, ASTHMA, REACT AGGRAV

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 12/8/2009

VAERS ID: 105612 Before After
VAERS Form:
Age:52.2
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-15 1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1997-1998 INFLUENZA (SEASONAL) (FLUVIRIN 97-98) / MEDEVA PHARMS LI MEDEVA PHARMA, LTD. - / - RA / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea, DIZZINESS, NAUSEA, ASTHMA, REACT AGGRAV

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem; MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 8/31/2010

VAERS ID: 105612 Before After
VAERS Form:
Age:52.2
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN 97-98) INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / - RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 7/7/2013

VAERS ID: 105612 Before After
VAERS Form:
Age:52.2
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / - RA / -
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / - RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 2/14/2017

VAERS ID: 105612 Before After
VAERS Form:
Age:52.2 52.0
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / - RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 5/14/2017

VAERS ID: 105612 Before After
VAERS Form:
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / - RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE NONE~ ()~~~In patient
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 9/14/2017

VAERS ID: 105612 Before After
VAERS Form:(blank) 1
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / - UNK RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 2/14/2018

VAERS ID: 105612 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 6/14/2018

VAERS ID: 105612 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 8/14/2018

VAERS ID: 105612 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 9/14/2018

VAERS ID: 105612 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 10/14/2018

VAERS ID: 105612 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 12/24/2020

VAERS ID: 105612 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 12/30/2020

VAERS ID: 105612 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 5/7/2021

VAERS ID: 105612 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;


Changed on 5/14/2021

VAERS ID: 105612 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:1997-10-21
Onset:1997-10-21
Submitted:1997-12-10
Entered:1997-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. - / UNK RA / -

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Condition aggravated, Dizziness, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: Provex CV
Current Illness:
Preexisting Conditions: allergics eggs confirmed by +skin & +RAST scats;mult chem sensitiities;allergic to metals & phenols;toxic effect of other pesticides, not elsewhere calssified status;hx chronic fever since 1972 may be d/to toxic exposures;sensory problem;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MPI971030

Write-up: pt recv vax 21OCT97 or 28OCT97 & approx 1hr p/vax became nauseous, felt like was going to pass out & started to wheeze;high fevers, burning in head, abn thinking;

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