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This is VAERS ID 26318

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26318
VAERS Form:
Age:92.0
Sex:Female
Location:Alabama
Vaccinated:1990-10-09
Onset:1990-10-11
Submitted:1990-10-17
Entered:1990-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1989-1990 / CONNAUGHT LABS 0F11216 / 0 A / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-12
Permanent Disability? No
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: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


Changed on 12/8/2009

VAERS ID: 26318 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:Alabama
Vaccinated:1990-10-09
Onset:1990-10-11
Submitted:1990-10-17
Entered:1990-10-31 1990-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1989-1990 INFLUENZA (SEASONAL) (FLUZONE 89-90) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11216 / 0 A / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Pyrexia, FEVER

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-12
Permanent Disability? No
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: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


Changed on 8/31/2010

VAERS ID: 26318 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:Alabama
Vaccinated:1990-10-09
Onset:1990-10-11
Submitted:1990-10-17
Entered:1990-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 89-90) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 0 A / IM

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-12
Permanent Disability? No
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: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


Changed on 7/7/2013

VAERS ID: 26318 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:Alabama
Vaccinated:1990-10-09
Onset:1990-10-11
Submitted:1990-10-17
Entered:1990-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 0 A / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 0 A / IM

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-12
Permanent Disability? No
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: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


Changed on 5/14/2017

VAERS ID: 26318 Before After
VAERS Form:
Age:92.0
Sex:Female
Location:Alabama
Vaccinated:1990-10-09
Onset:1990-10-11
Submitted:1990-10-17
Entered:1990-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 0 A - / IM IM A

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-12
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


Changed on 9/14/2017

VAERS ID: 26318 Before After
VAERS Form:(blank) 1
Age:92.0
Sex:Female
Location:Alabama
Vaccinated:1990-10-09
Onset:1990-10-11
Submitted:1990-10-17
Entered:1990-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 0 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-12
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


Changed on 2/14/2018

VAERS ID: 26318 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:Alabama
Vaccinated:1990-10-09
Onset:1990-10-11
Submitted:1990-10-17
Entered:1990-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-12
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


Changed on 6/14/2018

VAERS ID: 26318 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:Alabama
Vaccinated:1990-10-09
Onset:1990-10-11
Submitted:1990-10-17
Entered:1990-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-12
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


Changed on 8/14/2018

VAERS ID: 26318 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:Alabama
Vaccinated:1990-10-09
Onset:1990-10-11
Submitted:1990-10-17
Entered:1990-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-12
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


Changed on 9/14/2018

VAERS ID: 26318 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:Alabama
Vaccinated:1990-10-09
Onset:1990-10-11
Submitted:1990-10-17
Entered:1990-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-12
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.


Changed on 10/14/2018

VAERS ID: 26318 Before After
VAERS Form:1
Age:92.0
Sex:Female
Location:Alabama
Vaccinated:1990-10-09
Onset:1990-10-11
Submitted:1990-10-17
Entered:1990-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-12
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications: Dipyridamold, Furosemide,Dioctolose, Chloraseptic, Methyldopa ,MOM, Aldomet
Current Illness: Rt lacunar Infarct Temp Area, Hypertens.
Preexisting Conditions: Rt Hemispheric stroke /w lt hemiparesis, lt facial weakness, aphasia, dysarthria, hypertension, limited ambulatory ability 2nd to stoke
Allergies:
Diagnostic Lab Data: All lab work WNL
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Trivalent A&B at 11:00AM on 9OCT90 fever noted at 8:00AM 11OCT90 Pt died 2:30AM 12OCT90.

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