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This is VAERS ID 26837

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26837
VAERS Form:
Age:79.8
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH - / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: RASH, PAIN, EFFUS PLEURAL, HEM GI, SPLENOMEGALY

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


Changed on 12/8/2009

VAERS ID: 26837 Before After
VAERS Form:
Age:79.8
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-12-04 1990-11-28
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 - / - - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting, RASH, PAIN, EFFUS PLEURAL, HEM GI, SPLENOMEGALY

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


Changed on 8/31/2010

VAERS ID: 26837 Before After
VAERS Form:
Age:79.8
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


Changed on 7/7/2013

VAERS ID: 26837 Before After
VAERS Form:
Age:79.8
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


Changed on 12/14/2016

VAERS ID: 26837 Before After
VAERS Form:
Age:79.8
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


Changed on 2/14/2017

VAERS ID: 26837 Before After
VAERS Form:
Age:79.8 79.0
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


Changed on 5/14/2017

VAERS ID: 26837 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula formula~ ()~~~In patient
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


Changed on 9/14/2017

VAERS ID: 26837 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula~ ()~~~In patient
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


Changed on 2/14/2018

VAERS ID: 26837 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula~ ()~~~In patient
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


Changed on 6/14/2018

VAERS ID: 26837 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula~ ()~~~In patient
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


Changed on 8/14/2018

VAERS ID: 26837 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula~ ()~~~In patient
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


Changed on 9/14/2018

VAERS ID: 26837 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula~ ()~~~In patient
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.


Changed on 10/14/2018

VAERS ID: 26837 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Gastrointestinal haemorrhage, Pain, Pleural effusion, Rash, Splenomegaly, Vasculitis, Vomiting

Life Threatening? Yes
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: Vasculitis 1 wk /p previous vax of Influenza 89-90 formula~ ()~~~In patient
Other Medications: Synthroid, Aldactazide
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890311001B

Write-up: Pt vaccinated with Influenza developed vasculitis described as severe rash on her arms & legs. Also experienced pain & vomiting.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=26837&WAYBACKHISTORY=ON


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