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This is VAERS ID 27218

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27218
VAERS Form:
Age:89.7
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1991-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11221 / 1 A / IM

Administered by: Other      Purchased by: Unknown
Symptoms: COUGH INC, SPUTUM INC

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type':

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 12/8/2009

VAERS ID: 27218 Before After
VAERS Form:
Age:89.7
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1991-01-04 1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11221 / 1 A / IM

Administered by: Other      Purchased by: Unknown Public
Symptoms: Cough, Productive cough, COUGH INC, SPUTUM INC

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': (blank) LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 8/31/2010

VAERS ID: 27218 Before After
VAERS Form:
Age:89.7
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 1 A / IM

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 7/7/2013

VAERS ID: 27218 Before After
VAERS Form:
Age:89.7
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 1 A / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 1 A / IM

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 2/14/2017

VAERS ID: 27218 Before After
VAERS Form:
Age:89.7 89.0
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 1 A / IM

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 5/14/2017

VAERS ID: 27218 Before After
VAERS Form:
Age:89.0
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 1 A - / IM IM A

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 9/14/2017

VAERS ID: 27218 Before After
VAERS Form:(blank) 1
Age:89.0
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 1 2 - / IM A

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 2/14/2018

VAERS ID: 27218 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 2 - / IM A

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 6/14/2018

VAERS ID: 27218 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 2 - / IM A

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 8/14/2018

VAERS ID: 27218 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 2 - / IM A

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 9/14/2018

VAERS ID: 27218 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 2 - / IM A

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 10/14/2018

VAERS ID: 27218 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 2 - / IM A

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 12/24/2020

VAERS ID: 27218 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 2 - / IM A

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 12/30/2020

VAERS ID: 27218 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 2 - / IM A

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 5/7/2021

VAERS ID: 27218 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 2 - / IM A

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum


Changed on 5/14/2021

VAERS ID: 27218 Before After
VAERS Form:1
Age:89.0
Sex:Female
Location:Louisiana
Vaccinated:1990-11-01
Onset:1990-11-06
Submitted:1990-12-06
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11221 / 2 - / IM A

Administered by: Other      Purchased by: Public
Symptoms: Cough, Productive cough

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Vasotec, Bethanacol, Doriden, Verapamil, KCl.
Current Illness:
Preexisting Conditions: allergies to sulfa, hx of URI''s
Allergies:
Diagnostic Lab Data: 13NOV90 Bacterial Pneumonia culture
CDC 'Split Type': LA90121

Write-up: developed bad cough, no fever 5 days/p vax. Coughed up green sputum

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