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This is VAERS ID 27227

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27227
VAERS Form:
Age:63.0
Sex:Female
Location:Maine
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-12-18
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: PERICARDITIS

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered


Changed on 12/8/2009

VAERS ID: 27227 Before After
VAERS Form:
Age:63.0
Sex:Female
Location:Maine
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-12-18
Entered:1991-01-10 1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pericarditis, PERICARDITIS

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 904090016

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered


Changed on 8/31/2010

VAERS ID: 27227 Before After
VAERS Form:
Age:63.0
Sex:Female
Location:Maine
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-12-18
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pericarditis

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090016

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered


Changed on 7/7/2013

VAERS ID: 27227 Before After
VAERS Form:
Age:63.0
Sex:Female
Location:Maine
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-12-18
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pericarditis

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090016

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered


Changed on 5/14/2017

VAERS ID: 27227 Before After
VAERS Form:
Age:63.0
Sex:Female
Location:Maine
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-12-18
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pericarditis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090016

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered


Changed on 9/14/2017

VAERS ID: 27227 Before After
VAERS Form:(blank) 1
Age:63.0
Sex:Female
Location:Maine
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-12-18
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - UNK - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pericarditis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090016

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered


Changed on 2/14/2018

VAERS ID: 27227 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Maine
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-12-18
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pericarditis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090016

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered


Changed on 6/14/2018

VAERS ID: 27227 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Maine
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-12-18
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pericarditis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090016

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered


Changed on 8/14/2018

VAERS ID: 27227 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Maine
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-12-18
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pericarditis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090016

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered


Changed on 9/14/2018

VAERS ID: 27227 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Maine
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-12-18
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pericarditis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090016

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered


Changed on 10/14/2018

VAERS ID: 27227 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Maine
Vaccinated:1990-11-01
Onset:1990-11-10
Submitted:1990-12-18
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pericarditis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Glipizide, Indomethacin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090016

Write-up: pericarditis reported in pt who received Fluogen 10 days earlier, pt diabetic, Hospitalized, recovered

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