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This is VAERS ID 26463

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26463
VAERS Form:
Age:62.9
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908209 / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, APNEA, FLU SYND, ATELECTASIS, HYPOVENTIL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type':

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


Changed on 12/8/2009

VAERS ID: 26463 Before After
VAERS Form:
Age:62.9
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-07 1990-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) / WYETH WYETH PHARMACEUTICALS, INC 4908209 / - LA / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis, FEVER, APNEA, FLU SYND, ATELECTASIS, HYPOVENTIL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type': (blank) 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


Changed on 8/31/2010

VAERS ID: 26463 Before After
VAERS Form:
Age:62.9
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908209 / - LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type': 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


Changed on 7/7/2013

VAERS ID: 26463 Before After
VAERS Form:
Age:62.9
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type': 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


Changed on 12/14/2016

VAERS ID: 26463 Before After
VAERS Form:
Age:62.9
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type': 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


Changed on 2/14/2017

VAERS ID: 26463 Before After
VAERS Form:
Age:62.9 62.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type': 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


Changed on 5/14/2017

VAERS ID: 26463 Before After
VAERS Form:
Age:62.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type': 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


Changed on 9/14/2017

VAERS ID: 26463 Before After
VAERS Form:(blank) 1
Age:62.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type': 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


Changed on 2/14/2018

VAERS ID: 26463 Before After
VAERS Form:1
Age:62.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type': 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


Changed on 6/14/2018

VAERS ID: 26463 Before After
VAERS Form:1
Age:62.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type': 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


Changed on 8/14/2018

VAERS ID: 26463 Before After
VAERS Form:1
Age:62.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type': 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


Changed on 9/14/2018

VAERS ID: 26463 Before After
VAERS Form:1
Age:62.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type': 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX


Changed on 10/14/2018

VAERS ID: 26463 Before After
VAERS Form:1
Age:62.0
Sex:Female
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-01
Submitted:1990-10-17
Entered:1990-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Atelectasis, Hypoventilation, Influenza, Pneumonia, Pyrexia, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-16
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: NONE SPECIFIED
Current Illness: CANCER
Preexisting Conditions: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR
Allergies:
Diagnostic Lab Data: CHEST X-RAY: PNEUMONIA, BILAT BASILAR ATELECTASIS. WBC 13,900/CU.MM. LYMPHS = 9800/CU MM
CDC 'Split Type': 890291001B

Write-up: Pt dev flu-like resp sxs more than a wk /p being admin Flu vax. Pt expired, cause unknown, 16OCT90. F/U 05NOV90: PT WAS TERMINALLY ILL W/ MALIGNANT BRAIN TUMOR, DEV RESP COMPLICATIONS, SHALLOW BREATHING, T 101.8 & CONGESTION 12 D P/ VAX

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