National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 169665

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 169665
VAERS Form:
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUSHIELD 99-00) / WYETH 4008179 / - - / -

Administered by: Public      Purchased by: Unknown
Symptoms: PAIN INJECT SITE

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 12/8/2009

VAERS ID: 169665 Before After
VAERS Form:
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-17 2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUSHIELD 99-00) INFLUENZA (SEASONAL) (FLUSHIELD 99-00) / WYETH WYETH PHARMACEUTICALS, INC 4008179 / - - / -

Administered by: Public      Purchased by: Unknown Other
Symptoms: Injection site pain, PAIN INJECT SITE

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 8/31/2010

VAERS ID: 169665 Before After
VAERS Form:
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 99-00) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4008179 / - - / -

Administered by: Public      Purchased by: Other
Symptoms: Injection site pain

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 7/7/2013

VAERS ID: 169665 Before After
VAERS Form:
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008179 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008179 / - - / -

Administered by: Public      Purchased by: Other
Symptoms: Injection site pain

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 9/14/2017

VAERS ID: 169665 Before After
VAERS Form:(blank) 1
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008179 / - UNK - / -

Administered by: Public      Purchased by: Other
Symptoms: Injection site pain

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 2/14/2018

VAERS ID: 169665 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008179 / UNK - / -

Administered by: Public      Purchased by: Other
Symptoms: Injection site pain

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 6/14/2018

VAERS ID: 169665 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008179 / UNK - / -

Administered by: Public      Purchased by: Other
Symptoms: Injection site pain

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 8/14/2018

VAERS ID: 169665 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008179 / UNK - / -

Administered by: Public      Purchased by: Other
Symptoms: Injection site pain

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 9/14/2018

VAERS ID: 169665 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008179 / UNK - / -

Administered by: Public      Purchased by: Other
Symptoms: Injection site pain

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 10/14/2018

VAERS ID: 169665 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008179 / UNK - / -

Administered by: Public      Purchased by: Other
Symptoms: Injection site pain

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 12/24/2020

VAERS ID: 169665 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008179 / UNK - / -

Administered by: Public      Purchased by: Other
Symptoms: Injection site pain

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 12/30/2020

VAERS ID: 169665 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008179 / UNK - / -

Administered by: Public      Purchased by: Other
Symptoms: Injection site pain

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 5/7/2021

VAERS ID: 169665 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008179 / UNK - / -

Administered by: Public      Purchased by: Other
Symptoms: Injection site pain

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.


Changed on 5/14/2021

VAERS ID: 169665 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:New York
Vaccinated:2000-04-21
Onset:2000-04-25
Submitted:2001-05-01
Entered:2001-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008179 / UNK - / -

Administered by: Public      Purchased by: Other
Symptoms: Injection site pain

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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: x-ray 2 different times at the hospital.
CDC 'Split Type':

Write-up: This patient had pain in the area where her shots were administered. Saw own MD - x-rays (2 times). Orthopedic, Cortisone shot - physical therapy.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=169665&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166