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This is VAERS ID 26641

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26641
VAERS Form:
Age:44.8
Sex:Female
Location:Washington
Vaccinated:1990-11-09
Onset:1990-11-09
Submitted:1990-11-13
Entered:1990-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 02280P / 0 A / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: PAIN CHEST, PHARYNGITIS

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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.


Changed on 12/8/2009

VAERS ID: 26641 Before After
VAERS Form:
Age:44.8
Sex:Female
Location:Washington
Vaccinated:1990-11-09
Onset:1990-11-09
Submitted:1990-11-13
Entered:1990-11-20 1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS 02280P / 0 A / IM

Administered by: Unknown      Purchased by: Unknown Private
Symptoms: Chest pain, Pharyngitis, PAIN CHEST, PHARYNGITIS

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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.


Changed on 8/31/2010

VAERS ID: 26641 Before After
VAERS Form:
Age:44.8
Sex:Female
Location:Washington
Vaccinated:1990-11-09
Onset:1990-11-09
Submitted:1990-11-13
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02280P / 0 A / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest pain, Pharyngitis

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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.


Changed on 7/7/2013

VAERS ID: 26641 Before After
VAERS Form:
Age:44.8
Sex:Female
Location:Washington
Vaccinated:1990-11-09
Onset:1990-11-09
Submitted:1990-11-13
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02280P / 0 A / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02280P / 0 A / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest pain, Pharyngitis

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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.


Changed on 2/14/2017

VAERS ID: 26641 Before After
VAERS Form:
Age:44.8 44.0
Sex:Female
Location:Washington
Vaccinated:1990-11-09
Onset:1990-11-09
Submitted:1990-11-13
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02280P / 0 A / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Chest pain, Pharyngitis

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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.


Changed on 5/14/2017

VAERS ID: 26641 Before After
VAERS Form:
Age:44.0
Sex:Female
Location:Washington
Vaccinated:1990-11-09
Onset:1990-11-09
Submitted:1990-11-13
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02280P / 0 A - / IM IM A

Administered by: Unknown      Purchased by: Private
Symptoms: Chest pain, Pharyngitis

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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.


Changed on 9/14/2017

VAERS ID: 26641 Before After
VAERS Form:(blank) 1
Age:44.0
Sex:Female
Location:Washington
Vaccinated:1990-11-09
Onset:1990-11-09
Submitted:1990-11-13
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02280P / 0 1 - / IM A

Administered by: Unknown      Purchased by: Private
Symptoms: Chest pain, Pharyngitis

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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.


Changed on 2/14/2018

VAERS ID: 26641 Before After
VAERS Form:1
Age:44.0
Sex:Female
Location:Washington
Vaccinated:1990-11-09
Onset:1990-11-09
Submitted:1990-11-13
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02280P / 1 - / IM A

Administered by: Unknown      Purchased by: Private
Symptoms: Chest pain, Pharyngitis

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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.


Changed on 6/14/2018

VAERS ID: 26641 Before After
VAERS Form:1
Age:44.0
Sex:Female
Location:Washington
Vaccinated:1990-11-09
Onset:1990-11-09
Submitted:1990-11-13
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02280P / 1 - / IM A

Administered by: Unknown      Purchased by: Private
Symptoms: Chest pain, Pharyngitis

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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.


Changed on 8/14/2018

VAERS ID: 26641 Before After
VAERS Form:1
Age:44.0
Sex:Female
Location:Washington
Vaccinated:1990-11-09
Onset:1990-11-09
Submitted:1990-11-13
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02280P / 1 - / IM A

Administered by: Unknown      Purchased by: Private
Symptoms: Chest pain, Pharyngitis

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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.


Changed on 9/14/2018

VAERS ID: 26641 Before After
VAERS Form:1
Age:44.0
Sex:Female
Location:Washington
Vaccinated:1990-11-09
Onset:1990-11-09
Submitted:1990-11-13
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02280P / 1 - / IM A

Administered by: Unknown      Purchased by: Private
Symptoms: Chest pain, Pharyngitis

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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.


Changed on 10/14/2018

VAERS ID: 26641 Before After
VAERS Form:1
Age:44.0
Sex:Female
Location:Washington
Vaccinated:1990-11-09
Onset:1990-11-09
Submitted:1990-11-13
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02280P / 1 - / IM A

Administered by: Unknown      Purchased by: Private
Symptoms: Chest pain, Pharyngitis

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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=26641&WAYBACKHISTORY=ON


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