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This is VAERS ID 26871

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26871
VAERS Form:
Age:77.9
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908208 / - LA / -

Administered by: Public      Purchased by: Unknown
Symptoms: INJECT SITE REACT

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).


Changed on 12/8/2009

VAERS ID: 26871 Before After
VAERS Form:
Age:77.9
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-05 1990-12-03
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 4908208 / - LA / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Injection site reaction, INJECT SITE REACT

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) MI9002

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).


Changed on 8/31/2010

VAERS ID: 26871 Before After
VAERS Form:
Age:77.9
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908208 / - LA / -

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9002

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).


Changed on 7/7/2013

VAERS ID: 26871 Before After
VAERS Form:
Age:77.9
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / -

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9002

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).


Changed on 12/14/2016

VAERS ID: 26871 Before After
VAERS Form:
Age:77.9
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / -

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9002

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).


Changed on 2/14/2017

VAERS ID: 26871 Before After
VAERS Form:
Age:77.9 77.0
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / -

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9002

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).


Changed on 5/14/2017

VAERS ID: 26871 Before After
VAERS Form:
Age:77.0
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / -

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9002

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).


Changed on 9/14/2017

VAERS ID: 26871 Before After
VAERS Form:(blank) 1
Age:77.0
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - UNK LA / -

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9002

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).


Changed on 2/14/2018

VAERS ID: 26871 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / UNK LA / -

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9002

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).


Changed on 6/14/2018

VAERS ID: 26871 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / UNK LA / -

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9002

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).


Changed on 8/14/2018

VAERS ID: 26871 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / UNK LA / -

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9002

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).


Changed on 9/14/2018

VAERS ID: 26871 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / UNK LA / -

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9002

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).


Changed on 10/14/2018

VAERS ID: 26871 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:Michigan
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1990-11-02
Entered:1990-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / UNK LA / -

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

Life Threatening? No
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: Diabetic, Arthritis, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9002

Write-up: Pt vaccinated with Influenza red edematous area noted at injection site 3 min after injection. Pt did not bleed at time of injection or later- no bandage applied. Pt denies all questioned possible rxn- local & systemic (itching, dizzy).

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