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This is VAERS ID 26899

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26899
VAERS Form:
Age:40.5
Sex:Female
Location:California
Vaccinated:1990-11-15
Onset:1990-11-18
Submitted:1990-11-19
Entered:1990-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11203 / 0 LA / IM
TD: TD ADSORBED, ADULTS / SCLAVO 136A1 / - RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: HEADACHE, DYSPNEA, ASTHENIA, PHARYNGITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.


Changed on 12/8/2009

VAERS ID: 26899 Before After
VAERS Form:
Age:40.5
Sex:Female
Location:California
Vaccinated:1990-11-15
Onset:1990-11-18
Submitted:1990-11-19
Entered:1990-12-07 1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11203 / 0 LA / IM
TD: TD ADSORBED, ADULTS TD ADSORBED (NO BRAND NAME) / SCLAVO 136A1 / - RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Headache, Pharyngitis, HEADACHE, DYSPNEA, ASTHENIA, PHARYNGITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CA907

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.


Changed on 8/31/2010

VAERS ID: 26899 Before After
VAERS Form:
Age:40.5
Sex:Female
Location:California
Vaccinated:1990-11-15
Onset:1990-11-18
Submitted:1990-11-19
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 136A1 / - RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Headache, Pharyngitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA907

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.


Changed on 7/7/2013

VAERS ID: 26899 Before After
VAERS Form:
Age:40.5
Sex:Female
Location:California
Vaccinated:1990-11-15
Onset:1990-11-18
Submitted:1990-11-19
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 136A1 / - RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Headache, Pharyngitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA907

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.


Changed on 2/14/2017

VAERS ID: 26899 Before After
VAERS Form:
Age:40.5 40.0
Sex:Female
Location:California
Vaccinated:1990-11-15
Onset:1990-11-18
Submitted:1990-11-19
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 136A1 / - RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Headache, Pharyngitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA907

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.


Changed on 5/14/2017

VAERS ID: 26899 Before After
VAERS Form:
Age:40.0
Sex:Female
Location:California
Vaccinated:1990-11-15
Onset:1990-11-18
Submitted:1990-11-19
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 136A1 / - RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Headache, Pharyngitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA907

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.


Changed on 9/14/2017

VAERS ID: 26899 Before After
VAERS Form:(blank) 1
Age:40.0
Sex:Female
Location:California
Vaccinated:1990-11-15
Onset:1990-11-18
Submitted:1990-11-19
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 1 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 136A1 / - UNK RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Headache, Pharyngitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA907

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.


Changed on 2/14/2018

VAERS ID: 26899 Before After
VAERS Form:1
Age:40.0
Sex:Female
Location:California
Vaccinated:1990-11-15
Onset:1990-11-18
Submitted:1990-11-19
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 1 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 136A1 / UNK RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Headache, Pharyngitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA907

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.


Changed on 6/14/2018

VAERS ID: 26899 Before After
VAERS Form:1
Age:40.0
Sex:Female
Location:California
Vaccinated:1990-11-15
Onset:1990-11-18
Submitted:1990-11-19
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 1 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 136A1 / UNK RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Headache, Pharyngitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA907

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.


Changed on 8/14/2018

VAERS ID: 26899 Before After
VAERS Form:1
Age:40.0
Sex:Female
Location:California
Vaccinated:1990-11-15
Onset:1990-11-18
Submitted:1990-11-19
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 1 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 136A1 / UNK RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Headache, Pharyngitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA907

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.


Changed on 9/14/2018

VAERS ID: 26899 Before After
VAERS Form:1
Age:40.0
Sex:Female
Location:California
Vaccinated:1990-11-15
Onset:1990-11-18
Submitted:1990-11-19
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 1 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 136A1 / UNK RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Headache, Pharyngitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA907

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.


Changed on 10/14/2018

VAERS ID: 26899 Before After
VAERS Form:1
Age:40.0
Sex:Female
Location:California
Vaccinated:1990-11-15
Onset:1990-11-18
Submitted:1990-11-19
Entered:1990-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 1 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 136A1 / UNK RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Headache, Pharyngitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA907

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=26899&WAYBACKHISTORY=ON


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