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This is VAERS ID 27073

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27073
VAERS Form:
Age:64.5
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1989-1990 / CONNAUGHT LABS OJ11163 / 2 RA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: HEADACHE, FLU SYND, PAIN NECK, PHOTOPHOBIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type':

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 12/8/2009

VAERS ID: 27073 Before After
VAERS Form:
Age:64.5
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-19 1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1989-1990 INFLUENZA (SEASONAL) (FLUZONE 89-90) / CONNAUGHT LABS CONNAUGHT LABORATORIES OJ11163 / 2 RA / IM

Administered by: Other      Purchased by: Unknown Public
Symptoms: Headache, Influenza, Neck pain, Photophobia, HEADACHE, FLU SYND, PAIN NECK, PHOTOPHOBIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': (blank) WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 8/31/2010

VAERS ID: 27073 Before After
VAERS Form:
Age:64.5
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 89-90) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 2 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Headache, Influenza, Neck pain, Photophobia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 7/7/2013

VAERS ID: 27073 Before After
VAERS Form:
Age:64.5
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 2 RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 2 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Headache, Influenza, Neck pain, Photophobia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 2/14/2017

VAERS ID: 27073 Before After
VAERS Form:
Age:64.5 64.0
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 2 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Headache, Influenza, Neck pain, Photophobia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 5/14/2017

VAERS ID: 27073 Before After
VAERS Form:
Age:64.0
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 2 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Headache, Influenza, Neck pain, Photophobia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 9/14/2017

VAERS ID: 27073 Before After
VAERS Form:(blank) 1
Age:64.0
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 2 3 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Headache, Influenza, Neck pain, Photophobia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 2/14/2018

VAERS ID: 27073 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 3 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Headache, Influenza, Neck pain, Photophobia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 6/14/2018

VAERS ID: 27073 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 3 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Headache, Influenza, Neck pain, Photophobia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 8/14/2018

VAERS ID: 27073 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 3 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Headache, Influenza, Neck pain, Photophobia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 9/14/2018

VAERS ID: 27073 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 3 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Headache, Influenza, Neck pain, Photophobia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 10/14/2018

VAERS ID: 27073 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 3 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Headache, Influenza, Neck pain, Photophobia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 12/24/2020

VAERS ID: 27073 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 3 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Headache, Influenza, Neck pain, Photophobia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.


Changed on 12/30/2020

VAERS ID: 27073 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Washington
Vaccinated:1990-11-19
Onset:1990-11-20
Submitted:1990-11-27
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OJ11163 / 3 RA / IM

Administered by: Other      Purchased by: Public
Symptoms: Headache, Influenza, Neck pain, Photophobia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Coumadin, Digoxin
Current Illness:
Preexisting Conditions: MITRAL valve replacement; 1987 rt nephrectomy for CA osteoarthritis of spine & knee; diabetes mellitus 1987; hepatomegaly - fatty infiltration; 1986 diverticulosis, 1987 cholecystectomy.
Allergies:
Diagnostic Lab Data: CT SCAN & LUMBAR PUNCTURE NEGATIVE.
CDC 'Split Type': WA90496

Write-up: Pt vaccinated with INFLUENZA became ill one day after flu shot, headache severe/constant x 1 wk, significant neck discomfort, denies fever, chill, abdominal pain or seizures, denies trauma. Photophobia, final dx probable viral syndrome.

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