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This is VAERS ID 27228

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27228
VAERS Form:
Age:73.5
Sex:Male
Location:Unknown
Vaccinated:1990-11-27
Onset:1990-11-29
Submitted:1990-12-22
Entered:1991-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0J11019 / 0 RA / -

Administered by: Military      Purchased by: Unknown
Symptoms: HEADACHE, ARTHRALGIA, MALAISE, ASTHENIA, AMNESIA

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC 'Split Type':

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.


Changed on 12/8/2009

VAERS ID: 27228 Before After
VAERS Form:
Age:73.5
Sex:Male
Location:Unknown
Vaccinated:1990-11-27
Onset:1990-11-29
Submitted:1990-12-22
Entered:1991-01-11 1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0J11019 / 0 RA / -

Administered by: Military      Purchased by: Unknown
Symptoms: Amnesia, Arthralgia, Asthenia, Back pain, Headache, Malaise, Palpitations, Paraesthesia, HEADACHE, ARTHRALGIA, MALAISE, ASTHENIA, AMNESIA

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC 'Split Type':

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.


Changed on 8/31/2010

VAERS ID: 27228 Before After
VAERS Form:
Age:73.5
Sex:Male
Location:Unknown
Vaccinated:1990-11-27
Onset:1990-11-29
Submitted:1990-12-22
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11019 / 0 RA / -

Administered by: Military      Purchased by: Unknown
Symptoms: Amnesia, Arthralgia, Asthenia, Back pain, Headache, Malaise, Palpitations, Paraesthesia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC 'Split Type':

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.


Changed on 11/14/2011

VAERS ID: 27228 Before After
VAERS Form:
Age:73.5 73.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-27
Onset:1990-11-29
Submitted:1990-12-22
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11019 / 0 RA / -

Administered by: Military Unknown      Purchased by: Unknown
Symptoms: Amnesia, Arthralgia, Asthenia, Back pain, Headache, Malaise, Palpitations, Paraesthesia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC 'Split Type':

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.


Changed on 7/7/2013

VAERS ID: 27228 Before After
VAERS Form:
Age:73.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-27
Onset:1990-11-29
Submitted:1990-12-22
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11019 / 0 RA / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11019 / 0 RA / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Amnesia, Arthralgia, Asthenia, Back pain, Headache, Malaise, Palpitations, Paraesthesia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC 'Split Type':

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.


Changed on 9/14/2017

VAERS ID: 27228 Before After
VAERS Form:(blank) 1
Age:73.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-27
Onset:1990-11-29
Submitted:1990-12-22
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11019 / 0 1 RA / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Amnesia, Arthralgia, Asthenia, Back pain, Headache, Malaise, Palpitations, Paraesthesia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC 'Split Type':

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.


Changed on 2/14/2018

VAERS ID: 27228 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-27
Onset:1990-11-29
Submitted:1990-12-22
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11019 / 1 RA / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Amnesia, Arthralgia, Asthenia, Back pain, Headache, Malaise, Palpitations, Paraesthesia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC 'Split Type':

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.


Changed on 6/14/2018

VAERS ID: 27228 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-27
Onset:1990-11-29
Submitted:1990-12-22
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11019 / 1 RA / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Amnesia, Arthralgia, Asthenia, Back pain, Headache, Malaise, Palpitations, Paraesthesia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC 'Split Type':

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.


Changed on 8/14/2018

VAERS ID: 27228 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-27
Onset:1990-11-29
Submitted:1990-12-22
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11019 / 1 RA / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Amnesia, Arthralgia, Asthenia, Back pain, Headache, Malaise, Palpitations, Paraesthesia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC 'Split Type':

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.


Changed on 9/14/2018

VAERS ID: 27228 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-27
Onset:1990-11-29
Submitted:1990-12-22
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11019 / 1 RA / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Amnesia, Arthralgia, Asthenia, Back pain, Headache, Malaise, Palpitations, Paraesthesia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC 'Split Type':

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.


Changed on 10/14/2018

VAERS ID: 27228 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-27
Onset:1990-11-29
Submitted:1990-12-22
Entered:1990-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11019 / 1 RA / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Amnesia, Arthralgia, Asthenia, Back pain, Headache, Malaise, Palpitations, Paraesthesia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC 'Split Type':

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=27228&WAYBACKHISTORY=ON


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