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This is VAERS ID 197345

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 197345
VAERS Form:
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (UNKNOWN MFR) / UNKNOWN MFR - / - - / -

Administered by: Public      Purchased by: Unknown
Symptoms: ARTHRITIS, PAIN, JOINT DIS

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I"was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the o


Changed on 12/8/2009

VAERS ID: 197345 Before After
VAERS Form:
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (UNKNOWN MFR) INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MFR UNKNOWN MANUFACTURER - / - - / -

Administered by: Public      Purchased by: Unknown Private
Symptoms: Arthritis, Arthropathy, Pain, ARTHRITIS, PAIN, JOINT DIS

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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I"was I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the o original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.


Changed on 7/7/2013

VAERS ID: 197345 Before After
VAERS Form:
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Public      Purchased by: Private
Symptoms: Arthritis, Arthropathy, 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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.


Changed on 12/14/2016

VAERS ID: 197345 Before After
VAERS Form:
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Public      Purchased by: Private
Symptoms: Arthritis, Arthropathy, 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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.


Changed on 9/14/2017

VAERS ID: 197345 Before After
VAERS Form:(blank) 1
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Public      Purchased by: Private
Symptoms: Arthritis, Arthropathy, 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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.


Changed on 2/14/2018

VAERS ID: 197345 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public      Purchased by: Private
Symptoms: Arthritis, Arthropathy, 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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.


Changed on 6/14/2018

VAERS ID: 197345 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public      Purchased by: Private
Symptoms: Arthritis, Arthropathy, 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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.


Changed on 8/14/2018

VAERS ID: 197345 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public      Purchased by: Private
Symptoms: Arthritis, Arthropathy, 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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.


Changed on 9/14/2018

VAERS ID: 197345 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public      Purchased by: Private
Symptoms: Arthritis, Arthropathy, 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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.


Changed on 10/14/2018

VAERS ID: 197345 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public      Purchased by: Private
Symptoms: Arthritis, Arthropathy, 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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.


Changed on 12/24/2020

VAERS ID: 197345 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public      Purchased by: Private
Symptoms: Arthritis, Arthropathy, 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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.


Changed on 12/30/2020

VAERS ID: 197345 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public      Purchased by: Private
Symptoms: Arthritis, Arthropathy, 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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.


Changed on 5/7/2021

VAERS ID: 197345 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public      Purchased by: Private
Symptoms: Arthritis, Arthropathy, 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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.


Changed on 5/21/2021

VAERS ID: 197345 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New York
Vaccinated:1999-10-08
Onset:1999-10-08
Submitted:2003-02-05
Entered:2003-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public      Purchased by: Private
Symptoms: Arthritis, Arthropathy, 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: Birth Control Pills; Claritin; Flonase
Current Illness: N/A
Preexisting Conditions: Allergies: Seasonal, dust mites, mold, tree/grass pollens
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Shot was given up high on my right shoulder. Soreness from shot continued. 3/14/00: I discussed pain in shoulder with Dr. while in the office for other purpose-he thought immunization might have hit the bursas in my right shoulder. Tried 3 ibuprophin twice daily in Sept/Oct 2001. 10/29/01: Dr. referred me to physical therapy for right should pain. 11/16/01-12/27/01: went to physical therapy. The therapist suggested that there might be other problems beyond what therapy could do for me. 1/21/02: x-ray of right shoulder. 2/4/02: Dr. diagnosed osteoartritis in my right shoulder and gave me my 1st cortisone shot. 11/11/02: Returned to Dr. and received a 2nd cortosone shot. Shoulder is still painful from the arthitis in the same location as I had received the flu shot. The follow up states the date of the flu immunization is incorrect in the letter and on the authorizations for release of info. It should be 10/8/99, not 10/8/02. I changed the date. I didn''t provide the following info when I filed the original report. I was taking a prescription medication for cyclobenzaprine 10mg after seeing physician''s assistant. This was also for the right shoulder (muscle strain). I received physical therapy from 11/16/01-12/27/01. I didn''t give you the name of the provider in the original report. I''m mailing the authorizations for release of info today. Degenerate AC joint change.

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