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This is VAERS ID 25069

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25069
VAERS Form:
Age:34.0
Sex:Male
Location:Michigan
Vaccinated:1989-11-09
Onset:1989-11-15
Submitted:0000-00-00
Entered:1990-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1989-1990 TRIVALENT TYPES A&B / WYETH - / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: RASH, URTICARIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered


Changed on 12/8/2009

VAERS ID: 25069 Before After
VAERS Form:
Age:34.0
Sex:Male
Location:Michigan
Vaccinated:1989-11-09
Onset:1989-11-15
Submitted:0000-00-00
Entered:1990-07-12 1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1989-1990 TRIVALENT TYPES A&B INFLUENZA (SEASONAL) (NO BRAND NAME, 89-90) / WYETH WYETH PHARMACEUTICALS, INC - / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash, Urticaria, RASH, URTICARIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) B073089154

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered


Changed on 8/31/2010

VAERS ID: 25069 Before After
VAERS Form:
Age:34.0
Sex:Male
Location:Michigan
Vaccinated:1989-11-09
Onset:1989-11-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 89-90) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': B073089154

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered


Changed on 7/7/2013

VAERS ID: 25069 Before After
VAERS Form:
Age:34.0
Sex:Male
Location:Michigan
Vaccinated:1989-11-09
Onset:1989-11-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': B073089154

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered


Changed on 12/14/2016

VAERS ID: 25069 Before After
VAERS Form:
Age:34.0
Sex:Male
Location:Michigan
Vaccinated:1989-11-09
Onset:1989-11-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': B073089154

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered


Changed on 5/14/2017

VAERS ID: 25069 Before After
VAERS Form:
Age:34.0
Sex:Male
Location:Michigan
Vaccinated:1989-11-09
Onset:1989-11-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Preexisting Conditions: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': B073089154

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered


Changed on 9/14/2017

VAERS ID: 25069 Before After
VAERS Form:(blank) 1
Age:34.0
Sex:Male
Location:Michigan
Vaccinated:1989-11-09
Onset:1989-11-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Preexisting Conditions: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': B073089154

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered


Changed on 2/14/2018

VAERS ID: 25069 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:Michigan
Vaccinated:1989-11-09
Onset:1989-11-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Preexisting Conditions: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': B073089154

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered


Changed on 6/14/2018

VAERS ID: 25069 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:Michigan
Vaccinated:1989-11-09
Onset:1989-11-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Preexisting Conditions: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': B073089154

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered


Changed on 8/14/2018

VAERS ID: 25069 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:Michigan
Vaccinated:1989-11-09
Onset:1989-11-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Preexisting Conditions: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': B073089154

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered


Changed on 9/14/2018

VAERS ID: 25069 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:Michigan
Vaccinated:1989-11-09
Onset:1989-11-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Preexisting Conditions: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': B073089154

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered


Changed on 10/14/2018

VAERS ID: 25069 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:Michigan
Vaccinated:1989-11-09
Onset:1989-11-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Preexisting Conditions: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': B073089154

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered

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