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This is VAERS ID 27063

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27063
VAERS Form:
Age:27.2
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH - / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: PAIN INJECT SITE

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 12/8/2009

VAERS ID: 27063 Before After
VAERS Form:
Age:27.2
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1991-01-10 1990-12-17
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 - / - LA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Injection site pain, PAIN INJECT SITE

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 8/31/2010

VAERS ID: 27063 Before After
VAERS Form:
Age:27.2
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 7/7/2013

VAERS ID: 27063 Before After
VAERS Form:
Age:27.2
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 12/14/2016

VAERS ID: 27063 Before After
VAERS Form:
Age:27.2
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 2/14/2017

VAERS ID: 27063 Before After
VAERS Form:
Age:27.2 27.0
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 5/14/2017

VAERS ID: 27063 Before After
VAERS Form:
Age:27.0
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 9/14/2017

VAERS ID: 27063 Before After
VAERS Form:(blank) 1
Age:27.0
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 2/14/2018

VAERS ID: 27063 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 6/14/2018

VAERS ID: 27063 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 8/14/2018

VAERS ID: 27063 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 9/14/2018

VAERS ID: 27063 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 10/14/2018

VAERS ID: 27063 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 12/24/2020

VAERS ID: 27063 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 12/30/2020

VAERS ID: 27063 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 5/7/2021

VAERS ID: 27063 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist


Changed on 5/14/2021

VAERS ID: 27063 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:Ohio
Vaccinated:1990-11-05
Onset:0000-00-00
Submitted:1990-12-12
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: c/o lt upper arm soreness since vax given on 5Nov90, no visible or palpable rxn noted, treatment was to apply heat & follow up /w family md if symptoms persist

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=27063&WAYBACKHISTORY=ON


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