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This is VAERS ID 26861

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26861
VAERS Form:
Age:37.0
Sex:Female
Location:California
Vaccinated:1990-11-06
Onset:1990-11-06
Submitted:1990-11-16
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 02580P / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: HEADACHE, URTICARIA, PRURITUS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Demulen; Ceclor, Caleen.
Current Illness:
Preexisting Conditions: Atopic allergic synd. Mitial valve prolapse-sinusits
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Flu vaccine several minutes after injection developed large wheal, vessicles, pruritis & associated w/global headache. Rx Benadryl & hydrocortisone cream.


Changed on 12/8/2009

VAERS ID: 26861 Before After
VAERS Form:
Age:37.0
Sex:Female
Location:California
Vaccinated:1990-11-06
Onset:1990-11-06
Submitted:1990-11-16
Entered:1990-12-05 1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS 02580P / - LA / IM

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Headache, Pruritus, Urticaria, HEADACHE, URTICARIA, PRURITUS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Demulen; Ceclor, Caleen.
Current Illness:
Preexisting Conditions: Atopic allergic synd. Mitial valve prolapse-sinusits
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Flu vaccine several minutes after injection on deltoid developed large wheal, vessicles, pruritis & associated w/global headache. Rx Benadryl & hydrocortisone cream. Headache, pruritus urticaria


Changed on 8/31/2010

VAERS ID: 26861 Before After
VAERS Form:
Age:37.0
Sex:Female
Location:California
Vaccinated:1990-11-06
Onset:1990-11-06
Submitted:1990-11-16
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Headache, Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Demulen; Ceclor, Caleen.
Current Illness:
Preexisting Conditions: Atopic allergic synd. Mitial valve prolapse-sinusits
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: several minutes after injection on deltoid developed large wheal, vessicles, pruritis & associated w/global headache. Rx Benadryl & hydrocortisone cream. Headache, pruritus urticaria


Changed on 7/7/2013

VAERS ID: 26861 Before After
VAERS Form:
Age:37.0
Sex:Female
Location:California
Vaccinated:1990-11-06
Onset:1990-11-06
Submitted:1990-11-16
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Headache, Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Demulen; Ceclor, Caleen.
Current Illness:
Preexisting Conditions: Atopic allergic synd. Mitial valve prolapse-sinusits
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: several minutes after injection on deltoid developed large wheal, vessicles, pruritis & associated w/global headache. Rx Benadryl & hydrocortisone cream. Headache, pruritus urticaria


Changed on 9/14/2017

VAERS ID: 26861 Before After
VAERS Form:(blank) 1
Age:37.0
Sex:Female
Location:California
Vaccinated:1990-11-06
Onset:1990-11-06
Submitted:1990-11-16
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - UNK LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Headache, Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Demulen; Ceclor, Caleen.
Current Illness:
Preexisting Conditions: Atopic allergic synd. Mitial valve prolapse-sinusits
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: several minutes after injection on deltoid developed large wheal, vessicles, pruritis & associated w/global headache. Rx Benadryl & hydrocortisone cream. Headache, pruritus urticaria


Changed on 2/14/2018

VAERS ID: 26861 Before After
VAERS Form:1
Age:37.0
Sex:Female
Location:California
Vaccinated:1990-11-06
Onset:1990-11-06
Submitted:1990-11-16
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Headache, Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Demulen; Ceclor, Caleen.
Current Illness:
Preexisting Conditions: Atopic allergic synd. Mitial valve prolapse-sinusits
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: several minutes after injection on deltoid developed large wheal, vessicles, pruritis & associated w/global headache. Rx Benadryl & hydrocortisone cream. Headache, pruritus urticaria


Changed on 6/14/2018

VAERS ID: 26861 Before After
VAERS Form:1
Age:37.0
Sex:Female
Location:California
Vaccinated:1990-11-06
Onset:1990-11-06
Submitted:1990-11-16
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Headache, Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Demulen; Ceclor, Caleen.
Current Illness:
Preexisting Conditions: Atopic allergic synd. Mitial valve prolapse-sinusits
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: several minutes after injection on deltoid developed large wheal, vessicles, pruritis & associated w/global headache. Rx Benadryl & hydrocortisone cream. Headache, pruritus urticaria


Changed on 8/14/2018

VAERS ID: 26861 Before After
VAERS Form:1
Age:37.0
Sex:Female
Location:California
Vaccinated:1990-11-06
Onset:1990-11-06
Submitted:1990-11-16
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Headache, Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Demulen; Ceclor, Caleen.
Current Illness:
Preexisting Conditions: Atopic allergic synd. Mitial valve prolapse-sinusits
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: several minutes after injection on deltoid developed large wheal, vessicles, pruritis & associated w/global headache. Rx Benadryl & hydrocortisone cream. Headache, pruritus urticaria


Changed on 9/14/2018

VAERS ID: 26861 Before After
VAERS Form:1
Age:37.0
Sex:Female
Location:California
Vaccinated:1990-11-06
Onset:1990-11-06
Submitted:1990-11-16
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Headache, Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Demulen; Ceclor, Caleen.
Current Illness:
Preexisting Conditions: Atopic allergic synd. Mitial valve prolapse-sinusits
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: several minutes after injection on deltoid developed large wheal, vessicles, pruritis & associated w/global headache. Rx Benadryl & hydrocortisone cream. Headache, pruritus urticaria


Changed on 10/14/2018

VAERS ID: 26861 Before After
VAERS Form:1
Age:37.0
Sex:Female
Location:California
Vaccinated:1990-11-06
Onset:1990-11-06
Submitted:1990-11-16
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Headache, Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Demulen; Ceclor, Caleen.
Current Illness:
Preexisting Conditions: Atopic allergic synd. Mitial valve prolapse-sinusits
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: several minutes after injection on deltoid developed large wheal, vessicles, pruritis & associated w/global headache. Rx Benadryl & hydrocortisone cream. Headache, pruritus urticaria

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