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This is VAERS ID 26863

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26863
VAERS Form:
Age:72.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-10-31
Onset:1990-11-07
Submitted:1990-11-26
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11224 / 2 RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: PAIN CHEST, GASTROENTERITIS

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:
Allergies:
Diagnostic Lab Data: EKG - WNL
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same


Changed on 12/8/2009

VAERS ID: 26863 Before After
VAERS Form:
Age:72.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-10-31
Onset:1990-11-07
Submitted:1990-11-26
Entered:1990-12-05 1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11224 / 2 RA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Chest pain, Gastroenteritis, PAIN CHEST, GASTROENTERITIS

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:
Allergies:
Diagnostic Lab Data: EKG - WNL
CDC 'Split Type': (blank) MA900002

Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same


Changed on 8/31/2010

VAERS ID: 26863 Before After
VAERS Form:
Age:72.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-10-31
Onset:1990-11-07
Submitted:1990-11-26
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 2 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Gastroenteritis

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:
Allergies:
Diagnostic Lab Data: EKG - WNL
CDC 'Split Type': MA900002

Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same


Changed on 7/7/2013

VAERS ID: 26863 Before After
VAERS Form:
Age:72.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-10-31
Onset:1990-11-07
Submitted:1990-11-26
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 2 RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 2 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Gastroenteritis

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:
Allergies:
Diagnostic Lab Data: EKG - WNL
CDC 'Split Type': MA900002

Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same


Changed on 5/14/2017

VAERS ID: 26863 Before After
VAERS Form:
Age:72.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-10-31
Onset:1990-11-07
Submitted:1990-11-26
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 2 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Gastroenteritis

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:
Allergies:
Diagnostic Lab Data: EKG - WNL
CDC 'Split Type': MA900002

Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same


Changed on 9/14/2017

VAERS ID: 26863 Before After
VAERS Form:(blank) 1
Age:72.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-10-31
Onset:1990-11-07
Submitted:1990-11-26
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 2 3 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Gastroenteritis

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:
Allergies:
Diagnostic Lab Data: EKG - WNL
CDC 'Split Type': MA900002

Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same


Changed on 2/14/2018

VAERS ID: 26863 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-10-31
Onset:1990-11-07
Submitted:1990-11-26
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 3 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Gastroenteritis

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:
Allergies:
Diagnostic Lab Data: EKG - WNL
CDC 'Split Type': MA900002

Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same


Changed on 6/14/2018

VAERS ID: 26863 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-10-31
Onset:1990-11-07
Submitted:1990-11-26
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 3 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Gastroenteritis

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:
Allergies:
Diagnostic Lab Data: EKG - WNL
CDC 'Split Type': MA900002

Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same


Changed on 8/14/2018

VAERS ID: 26863 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-10-31
Onset:1990-11-07
Submitted:1990-11-26
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 3 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Gastroenteritis

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:
Allergies:
Diagnostic Lab Data: EKG - WNL
CDC 'Split Type': MA900002

Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same


Changed on 9/14/2018

VAERS ID: 26863 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-10-31
Onset:1990-11-07
Submitted:1990-11-26
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 3 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Gastroenteritis

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:
Allergies:
Diagnostic Lab Data: EKG - WNL
CDC 'Split Type': MA900002

Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same


Changed on 10/14/2018

VAERS ID: 26863 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Massachusetts
Vaccinated:1990-10-31
Onset:1990-11-07
Submitted:1990-11-26
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 3 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest pain, Gastroenteritis

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:
Allergies:
Diagnostic Lab Data: EKG - WNL
CDC 'Split Type': MA900002

Write-up: Pt vaccinated with Influenza seven days following flu shot, developed severe gastroenteritis & chest pain. Physical exam revealed no cardiac involvement, gastroenteritis relieved by antacid. No unusual food taken; wife not ill and ate same

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