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This is VAERS ID 26838

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26838
VAERS Form:
Age:
Sex:Unknown
Location:Arizona
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-11-15
Entered:1990-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: RESPIRAT DIS

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.


Changed on 12/8/2009

VAERS ID: 26838 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Arizona
Vaccinated:0000-00-00
Onset:0000-00-00
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 - / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Respiratory disorder, RESPIRAT DIS

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC 'Split Type': (blank) 890311002B

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.


Changed on 8/31/2010

VAERS ID: 26838 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Arizona
Vaccinated:0000-00-00
Onset:0000-00-00
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 - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC 'Split Type': 890311002B

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.


Changed on 7/7/2013

VAERS ID: 26838 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Arizona
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC 'Split Type': 890311002B

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.


Changed on 12/14/2016

VAERS ID: 26838 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Arizona
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC 'Split Type': 890311002B

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.


Changed on 5/14/2017

VAERS ID: 26838 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Arizona
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC 'Split Type': 890311002B

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.


Changed on 9/14/2017

VAERS ID: 26838 Before After
VAERS Form:(blank) 1
Age:
Sex:Unknown
Location:Arizona
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC 'Split Type': 890311002B

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.


Changed on 2/14/2018

VAERS ID: 26838 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Arizona
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC 'Split Type': 890311002B

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.


Changed on 6/14/2018

VAERS ID: 26838 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Arizona
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC 'Split Type': 890311002B

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.


Changed on 8/14/2018

VAERS ID: 26838 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Arizona
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC 'Split Type': 890311002B

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.


Changed on 9/14/2018

VAERS ID: 26838 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Arizona
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC 'Split Type': 890311002B

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.


Changed on 10/14/2018

VAERS ID: 26838 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Arizona
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-11-15
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray: Pleural effusion
CDC 'Split Type': 890311002B

Write-up: Pt vaccinated with Influenza developed adult respiratory distress synd following administration of Influenza Virus Vaccine. Considered to be life threatening.

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