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This is VAERS ID 26615

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26615
VAERS Form:
Age:49.6
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908192 / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: FEVER, RASH, PRURITUS, HERPES ZOSTER

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


Changed on 12/8/2009

VAERS ID: 26615 Before After
VAERS Form:
Age:49.6
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-14 1990-11-13
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 4908192 / - LA / IM

Administered by: Other      Purchased by: Unknown Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash, FEVER, RASH, PRURITUS, HERPES ZOSTER

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


Changed on 8/31/2010

VAERS ID: 26615 Before After
VAERS Form:
Age:49.6
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908192 / - LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


Changed on 7/7/2013

VAERS ID: 26615 Before After
VAERS Form:
Age:49.6
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-13
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: Other      Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


Changed on 12/14/2016

VAERS ID: 26615 Before After
VAERS Form:
Age:49.6
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-13
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: Other      Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


Changed on 2/14/2017

VAERS ID: 26615 Before After
VAERS Form:
Age:49.6 49.0
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / - LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


Changed on 5/14/2017

VAERS ID: 26615 Before After
VAERS Form:
Age:49.0
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / - LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


Changed on 9/14/2017

VAERS ID: 26615 Before After
VAERS Form:(blank) 1
Age:49.0
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / - UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


Changed on 2/14/2018

VAERS ID: 26615 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


Changed on 6/14/2018

VAERS ID: 26615 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


Changed on 8/14/2018

VAERS ID: 26615 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


Changed on 9/14/2018

VAERS ID: 26615 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


Changed on 10/14/2018

VAERS ID: 26615 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Ohio
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-05
Entered:1990-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / UNK LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=26615&WAYBACKHISTORY=ON


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