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This is VAERS ID 26864

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26864
VAERS Form:
Age:58.6
Sex:Female
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-11-15
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11224 / 0 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: CHILLS, FEVER, 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:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.


Changed on 12/8/2009

VAERS ID: 26864 Before After
VAERS Form:
Age:58.6
Sex:Female
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-11-15
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 / 0 RA / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Chills, Gastroenteritis, Pyrexia, CHILLS, FEVER, 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:
CDC 'Split Type': (blank) MA900003

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.


Changed on 8/31/2010

VAERS ID: 26864 Before After
VAERS Form:
Age:58.6
Sex:Female
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-11-15
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 0 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Chills, Gastroenteritis, Pyrexia

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:
CDC 'Split Type': MA900003

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.


Changed on 7/7/2013

VAERS ID: 26864 Before After
VAERS Form:
Age:58.6
Sex:Female
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-11-15
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 0 RA / SC
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 0 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Chills, Gastroenteritis, Pyrexia

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:
CDC 'Split Type': MA900003

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.


Changed on 2/14/2017

VAERS ID: 26864 Before After
VAERS Form:
Age:58.6 58.0
Sex:Female
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-11-15
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 0 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Chills, Gastroenteritis, Pyrexia

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:
CDC 'Split Type': MA900003

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.


Changed on 5/14/2017

VAERS ID: 26864 Before After
VAERS Form:
Age:58.0
Sex:Female
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-11-15
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 0 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Chills, Gastroenteritis, Pyrexia

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:
CDC 'Split Type': MA900003

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.


Changed on 9/14/2017

VAERS ID: 26864 Before After
VAERS Form:(blank) 1
Age:58.0
Sex:Female
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-11-15
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 0 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Chills, Gastroenteritis, Pyrexia

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:
CDC 'Split Type': MA900003

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.


Changed on 2/14/2018

VAERS ID: 26864 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-11-15
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Chills, Gastroenteritis, Pyrexia

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:
CDC 'Split Type': MA900003

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.


Changed on 6/14/2018

VAERS ID: 26864 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-11-15
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Chills, Gastroenteritis, Pyrexia

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:
CDC 'Split Type': MA900003

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.


Changed on 8/14/2018

VAERS ID: 26864 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-11-15
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Chills, Gastroenteritis, Pyrexia

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:
CDC 'Split Type': MA900003

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.


Changed on 9/14/2018

VAERS ID: 26864 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-11-15
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Chills, Gastroenteritis, Pyrexia

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:
CDC 'Split Type': MA900003

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.


Changed on 10/14/2018

VAERS ID: 26864 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Massachusetts
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-11-15
Entered:1990-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11224 / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Chills, Gastroenteritis, Pyrexia

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:
CDC 'Split Type': MA900003

Write-up: Pt vaccinated with Influenza nine days following injection, pt developed fever up to 104, chills & mild gastroenteritis. No other URI complications. Symptoms persist to date.

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