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This is VAERS ID 27338

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27338
VAERS Form:
Age:77.1
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1990-11-30
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11203 / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: RHINITIS, ASTHMA, MYALGIA, PAIN ABDO, ASTHENIA

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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.


Changed on 12/8/2009

VAERS ID: 27338 Before After
VAERS Form:
Age:77.1
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1990-11-30
Entered:1991-01-10 1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11203 / - LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Abdominal pain, Asthenia, Asthma, Myalgia, Rhinitis, Sepsis, RHINITIS, ASTHMA, MYALGIA, PAIN ABDO, ASTHENIA

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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CA9026

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.


Changed on 8/31/2010

VAERS ID: 27338 Before After
VAERS Form:
Age:77.1
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1990-11-30
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Asthma, Myalgia, Rhinitis, Sepsis

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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9026

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.


Changed on 7/7/2013

VAERS ID: 27338 Before After
VAERS Form:
Age:77.1
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1990-11-30
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Asthma, Myalgia, Rhinitis, Sepsis

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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9026

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.


Changed on 2/14/2017

VAERS ID: 27338 Before After
VAERS Form:
Age:77.1 77.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1990-11-30
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Asthma, Myalgia, Rhinitis, Sepsis

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: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9026

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.


Changed on 5/14/2017

VAERS ID: 27338 Before After
VAERS Form:
Age:77.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1990-11-30
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Asthma, Myalgia, Rhinitis, Sepsis

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: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9026

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.


Changed on 9/14/2017

VAERS ID: 27338 Before After
VAERS Form:(blank) 1
Age:77.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1990-11-30
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / - UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Asthma, Myalgia, Rhinitis, Sepsis

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: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9026

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.


Changed on 2/14/2018

VAERS ID: 27338 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1990-11-30
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Asthma, Myalgia, Rhinitis, Sepsis

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: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9026

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.


Changed on 6/14/2018

VAERS ID: 27338 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1990-11-30
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Asthma, Myalgia, Rhinitis, Sepsis

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: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9026

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.


Changed on 8/14/2018

VAERS ID: 27338 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1990-11-30
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Asthma, Myalgia, Rhinitis, Sepsis

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: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9026

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.


Changed on 9/14/2018

VAERS ID: 27338 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1990-11-30
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Asthma, Myalgia, Rhinitis, Sepsis

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: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9026

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.


Changed on 10/14/2018

VAERS ID: 27338 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1990-11-30
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Asthma, Myalgia, Rhinitis, Sepsis

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: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: during hospitalization: Theodur, Prednisone, Ventolin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9026

Write-up: Pt vaccinated with Influenza developed abd cramps, runny nose, no fever, fell on floor, unable to get up for 2 hrs, fell again, couldnt move for 4 hrs, saw MD dx asthmatic bronchitis, rx to Flu vaccine, E. Coli in blood-poss bladder infect.

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