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This is VAERS ID 26223

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26223
VAERS Form:
Age:62.0
Sex:Female
Location:Idaho
Vaccinated:1990-09-21
Onset:1990-09-21
Submitted:0000-00-00
Entered:1990-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1989-1990 TRIVALENT TYPES A&B / WYETH 4908192 / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: INJECT SITE REACT

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.


Changed on 12/8/2009

VAERS ID: 26223 Before After
VAERS Form:
Age:62.0
Sex:Female
Location:Idaho
Vaccinated:1990-09-21
Onset:1990-09-21
Submitted:0000-00-00
Entered:1990-10-16 1990-10-12
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 4908192 / - LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Injection site reaction, INJECT SITE REACT

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.


Changed on 8/31/2010

VAERS ID: 26223 Before After
VAERS Form:
Age:62.0
Sex:Female
Location:Idaho
Vaccinated:1990-09-21
Onset:1990-09-21
Submitted:0000-00-00
Entered:1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 89-90) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908192 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.


Changed on 7/7/2013

VAERS ID: 26223 Before After
VAERS Form:
Age:62.0
Sex:Female
Location:Idaho
Vaccinated:1990-09-21
Onset:1990-09-21
Submitted:0000-00-00
Entered:1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.


Changed on 12/14/2016

VAERS ID: 26223 Before After
VAERS Form:
Age:62.0
Sex:Female
Location:Idaho
Vaccinated:1990-09-21
Onset:1990-09-21
Submitted:0000-00-00
Entered:1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / - LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.


Changed on 5/14/2017

VAERS ID: 26223 Before After
VAERS Form:
Age:62.0
Sex:Female
Location:Idaho
Vaccinated:1990-09-21
Onset:1990-09-21
Submitted:0000-00-00
Entered:1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.


Changed on 9/14/2017

VAERS ID: 26223 Before After
VAERS Form:(blank) 1
Age:62.0
Sex:Female
Location:Idaho
Vaccinated:1990-09-21
Onset:1990-09-21
Submitted:0000-00-00
Entered:1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / - UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.


Changed on 2/14/2018

VAERS ID: 26223 Before After
VAERS Form:1
Age:62.0
Sex:Female
Location:Idaho
Vaccinated:1990-09-21
Onset:1990-09-21
Submitted:0000-00-00
Entered:1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.


Changed on 6/14/2018

VAERS ID: 26223 Before After
VAERS Form:1
Age:62.0
Sex:Female
Location:Idaho
Vaccinated:1990-09-21
Onset:1990-09-21
Submitted:0000-00-00
Entered:1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.


Changed on 8/14/2018

VAERS ID: 26223 Before After
VAERS Form:1
Age:62.0
Sex:Female
Location:Idaho
Vaccinated:1990-09-21
Onset:1990-09-21
Submitted:0000-00-00
Entered:1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.


Changed on 9/14/2018

VAERS ID: 26223 Before After
VAERS Form:1
Age:62.0
Sex:Female
Location:Idaho
Vaccinated:1990-09-21
Onset:1990-09-21
Submitted:0000-00-00
Entered:1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.


Changed on 10/14/2018

VAERS ID: 26223 Before After
VAERS Form:1
Age:62.0
Sex:Female
Location:Idaho
Vaccinated:1990-09-21
Onset:1990-09-21
Submitted:0000-00-00
Entered:1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=26223&WAYBACKHISTORY=ON


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