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This is VAERS ID 26605

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26605
VAERS Form:
Age:75.8
Sex:Male
Location:Virginia
Vaccinated:1990-10-30
Onset:1990-10-30
Submitted:1990-11-01
Entered:1990-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS OF11200 / - RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


Changed on 12/8/2009

VAERS ID: 26605 Before After
VAERS Form:
Age:75.8
Sex:Male
Location:Virginia
Vaccinated:1990-10-30
Onset:1990-10-30
Submitted:1990-11-01
Entered:1990-11-13 1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES OF11200 / - RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


Changed on 8/31/2010

VAERS ID: 26605 Before After
VAERS Form:
Age:75.8
Sex:Male
Location:Virginia
Vaccinated:1990-10-30
Onset:1990-10-30
Submitted:1990-11-01
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11200 / - RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


Changed on 7/7/2013

VAERS ID: 26605 Before After
VAERS Form:
Age:75.8
Sex:Male
Location:Virginia
Vaccinated:1990-10-30
Onset:1990-10-30
Submitted:1990-11-01
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11200 / - RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11200 / - RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


Changed on 2/14/2017

VAERS ID: 26605 Before After
VAERS Form:
Age:75.8 75.0
Sex:Male
Location:Virginia
Vaccinated:1990-10-30
Onset:1990-10-30
Submitted:1990-11-01
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11200 / - RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


Changed on 5/14/2017

VAERS ID: 26605 Before After
VAERS Form:
Age:75.0
Sex:Male
Location:Virginia
Vaccinated:1990-10-30
Onset:1990-10-30
Submitted:1990-11-01
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11200 / - RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


Changed on 9/14/2017

VAERS ID: 26605 Before After
VAERS Form:(blank) 1
Age:75.0
Sex:Male
Location:Virginia
Vaccinated:1990-10-30
Onset:1990-10-30
Submitted:1990-11-01
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11200 / - UNK RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


Changed on 2/14/2018

VAERS ID: 26605 Before After
VAERS Form:1
Age:75.0
Sex:Male
Location:Virginia
Vaccinated:1990-10-30
Onset:1990-10-30
Submitted:1990-11-01
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11200 / UNK RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


Changed on 6/14/2018

VAERS ID: 26605 Before After
VAERS Form:1
Age:75.0
Sex:Male
Location:Virginia
Vaccinated:1990-10-30
Onset:1990-10-30
Submitted:1990-11-01
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11200 / UNK RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


Changed on 8/14/2018

VAERS ID: 26605 Before After
VAERS Form:1
Age:75.0
Sex:Male
Location:Virginia
Vaccinated:1990-10-30
Onset:1990-10-30
Submitted:1990-11-01
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11200 / UNK RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


Changed on 9/14/2018

VAERS ID: 26605 Before After
VAERS Form:1
Age:75.0
Sex:Male
Location:Virginia
Vaccinated:1990-10-30
Onset:1990-10-30
Submitted:1990-11-01
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11200 / UNK RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


Changed on 10/14/2018

VAERS ID: 26605 Before After
VAERS Form:1
Age:75.0
Sex:Male
Location:Virginia
Vaccinated:1990-10-30
Onset:1990-10-30
Submitted:1990-11-01
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11200 / UNK RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chills, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=26605&WAYBACKHISTORY=ON


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