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This is VAERS ID 27222

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27222
VAERS Form:
Age:73.4
Sex:Female
Location:Alabama
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1991-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 02380P / - LA / IM
PPV: PNU-IMUNE(R)23 / LEDERLE 289905 / 0 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: STOMATITIS

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? No
Previous Vaccinations:
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 12/8/2009

VAERS ID: 27222 Before After
VAERS Form:
Age:73.4
Sex:Female
Location:Alabama
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1991-01-04 1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS 02380P / - LA / IM
PPV: PNU-IMUNE(R)23 PNEUMO (PNU-IMUNE) / LEDERLE LEDERLE LABORATORIES 289905 / 0 RA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Stomatitis, STOMATITIS

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? No
Previous Vaccinations:
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 8/31/2010

VAERS ID: 27222 Before After
VAERS Form:
Age:73.4
Sex:Female
Location:Alabama
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / - LA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 289905 / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations:
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 7/7/2013

VAERS ID: 27222 Before After
VAERS Form:
Age:73.4
Sex:Female
Location:Alabama
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / - LA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 289905 / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations:
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 2/14/2017

VAERS ID: 27222 Before After
VAERS Form:
Age:73.4 73.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / - LA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 289905 / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations:
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 5/14/2017

VAERS ID: 27222 Before After
VAERS Form:
Age:73.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / - LA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 289905 / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 9/14/2017

VAERS ID: 27222 Before After
VAERS Form:(blank) 1
Age:73.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / - UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289905 / 0 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 2/14/2018

VAERS ID: 27222 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289905 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 6/14/2018

VAERS ID: 27222 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289905 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 8/14/2018

VAERS ID: 27222 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289905 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 9/14/2018

VAERS ID: 27222 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289905 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 10/14/2018

VAERS ID: 27222 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289905 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 12/10/2020

VAERS ID: 27222 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:Alabama Arizona
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289905 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 12/24/2020

VAERS ID: 27222 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:Arizona
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289905 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 12/30/2020

VAERS ID: 27222 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:Arizona
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289905 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 5/7/2021

VAERS ID: 27222 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:Arizona
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289905 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection


Changed on 5/14/2021

VAERS ID: 27222 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:Arizona
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-12-20
Entered:1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02380P / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 289905 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Stomatitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lanoxin. Bufferin
Current Illness:
Preexisting Conditions: TIA, Diverticulosis, Atrial Tachycardia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomatitis one day /p injection

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