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This is VAERS ID 27159

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27159
VAERS Form:
Age:69.9
Sex:Female
Location:North Carolina
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted:1990-12-17
Entered:1991-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS OF11208 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: FLU SYND, COUGH INC, BRONCHITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC 'Split Type':

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


Changed on 12/8/2009

VAERS ID: 27159 Before After
VAERS Form:
Age:69.9
Sex:Female
Location:North Carolina
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted:1990-12-17
Entered:1991-01-11 1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES OF11208 / - - / -

Administered by: Private      Purchased by: Unknown Public
Symptoms: Bronchitis, Cough, Influenza, FLU SYND, COUGH INC, BRONCHITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC 'Split Type':

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


Changed on 8/31/2010

VAERS ID: 27159 Before After
VAERS Form:
Age:69.9
Sex:Female
Location:North Carolina
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / - - / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC 'Split Type':

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


Changed on 7/7/2013

VAERS ID: 27159 Before After
VAERS Form:
Age:69.9
Sex:Female
Location:North Carolina
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / - - / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC 'Split Type':

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


Changed on 2/14/2017

VAERS ID: 27159 Before After
VAERS Form:
Age:69.9 69.0
Sex:Female
Location:North Carolina
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / - - / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC 'Split Type':

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


Changed on 5/14/2017

VAERS ID: 27159 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:North Carolina
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / - - / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC 'Split Type':

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


Changed on 9/14/2017

VAERS ID: 27159 Before After
VAERS Form:(blank) 1
Age:69.0
Sex:Female
Location:North Carolina
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / - UNK - / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC 'Split Type':

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


Changed on 2/14/2018

VAERS ID: 27159 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:North Carolina
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / UNK - / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC 'Split Type':

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


Changed on 6/14/2018

VAERS ID: 27159 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:North Carolina
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / UNK - / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC 'Split Type':

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


Changed on 8/14/2018

VAERS ID: 27159 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:North Carolina
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / UNK - / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC 'Split Type':

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


Changed on 9/14/2018

VAERS ID: 27159 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:North Carolina
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / UNK - / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC 'Split Type':

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.


Changed on 10/14/2018

VAERS ID: 27159 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:North Carolina
Vaccinated:1990-11-26
Onset:0000-00-00
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11208 / UNK - / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cough, Influenza

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Phenylpropanolamine w/ Guaiafenisin (generic Entex LA)
Current Illness: ganglion wrist
Preexisting Conditions: Penicillin by hx
Allergies:
Diagnostic Lab Data: WBC 6,200; HGB 17.4; x-ray negative
CDC 'Split Type':

Write-up: Pt vaccinated w/FLUZONE developed cold next day - upper respir then cough. Seen by MD; normal WBC & HGB, but had cough w/ yellow mucous. Chest x-ray negative. Treated for bacterial bronchitis; improved for 2 days. Found dead 2 days later.

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