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This is VAERS ID 27363

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27363
VAERS Form:
Age:66.5
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908199 / 1 RA / IM
PPV: PNEUMOVAX 23 / MSD 18565 / 0 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: CHILLS, FEVER, TREMOR, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 12/8/2009

VAERS ID: 27363 Before After
VAERS Form:
Age:66.5
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-14 1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) / WYETH WYETH PHARMACEUTICALS, INC 4908199 / 1 RA / IM
PPV: PNEUMOVAX 23 PNEUMO (PNEUMOVAX) / MSD MERCK & CO. INC. 18565 / 0 LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor, CHILLS, FEVER, TREMOR, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 8/31/2010

VAERS ID: 27363 Before After
VAERS Form:
Age:66.5
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908199 / 1 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 7/7/2013

VAERS ID: 27363 Before After
VAERS Form:
Age:66.5
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 1 RA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 1 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 12/14/2016

VAERS ID: 27363 Before After
VAERS Form:
Age:66.5
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 1 RA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 1 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 2/14/2017

VAERS ID: 27363 Before After
VAERS Form:
Age:66.5 66.0
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 1 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 5/14/2017

VAERS ID: 27363 Before After
VAERS Form:
Age:66.0
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 1 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 9/14/2017

VAERS ID: 27363 Before After
VAERS Form:(blank) 1
Age:66.0
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 1 2 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 0 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 2/14/2018

VAERS ID: 27363 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 2 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 6/14/2018

VAERS ID: 27363 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 2 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 8/14/2018

VAERS ID: 27363 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 2 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 9/14/2018

VAERS ID: 27363 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 2 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 10/14/2018

VAERS ID: 27363 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 2 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 12/24/2020

VAERS ID: 27363 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 2 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 12/30/2020

VAERS ID: 27363 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 2 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 5/7/2021

VAERS ID: 27363 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 2 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.


Changed on 5/14/2021

VAERS ID: 27363 Before After
VAERS Form:1
Age:66.0
Sex:Male
Location:Georgia
Vaccinated:1990-11-19
Onset:1990-11-19
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908199 / 2 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 18565 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Chills, Pyrexia, Tremor

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:
Current Illness:
Preexisting Conditions: prostate problems - heart bypass
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9015

Write-up: Pt vaccinated with PNEUMOVAC/FLU developed chills & fever approx 5 hrs after inject - visited ER w/weakness & shaking all over E61 SMA 18, Chest x-ray, CBC & U/A all normal.

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