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This is VAERS ID 27081

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27081
VAERS Form:
Age:62.1
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1991-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11222 / 1 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: DYSPNEA, PRURITUS, PARESTHESIA

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 12/8/2009

VAERS ID: 27081 Before After
VAERS Form:
Age:62.1
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1991-01-09 1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11222 / 1 LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus, DYSPNEA, PRURITUS, PARESTHESIA

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 8/31/2010

VAERS ID: 27081 Before After
VAERS Form:
Age:62.1
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 7/7/2013

VAERS ID: 27081 Before After
VAERS Form:
Age:62.1
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 1 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 2/14/2017

VAERS ID: 27081 Before After
VAERS Form:
Age:62.1 62.0
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 5/14/2017

VAERS ID: 27081 Before After
VAERS Form:
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 9/14/2017

VAERS ID: 27081 Before After
VAERS Form:(blank) 1
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 1 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 2/14/2018

VAERS ID: 27081 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 6/14/2018

VAERS ID: 27081 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 8/14/2018

VAERS ID: 27081 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 9/14/2018

VAERS ID: 27081 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 10/14/2018

VAERS ID: 27081 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 12/24/2020

VAERS ID: 27081 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 12/30/2020

VAERS ID: 27081 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 5/7/2021

VAERS ID: 27081 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


Changed on 5/14/2021

VAERS ID: 27081 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:1990-11-19
Onset:1990-11-21
Submitted:1990-11-26
Entered:1990-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Paraesthesia, Pruritus

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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9005

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=27081&WAYBACKHISTORY=ON

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