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This is VAERS ID 27404

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27404
VAERS Form:
Age:66.6
Sex:Female
Location:Oklahoma
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1991-01-10
Entered:1991-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11217 / 1 RA / IM
PPV: PNU-IMUNE(R)23 / LEDERLE 293978 / 2 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: INJECT SITE REACT

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Local reaction.


Changed on 12/8/2009

VAERS ID: 27404 Before After
VAERS Form:
Age:66.6
Sex:Female
Location:Oklahoma
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1991-01-10
Entered:1991-01-16 1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11217 / 1 RA / IM
PPV: PNU-IMUNE(R)23 PNEUMO (PNU-IMUNE) / LEDERLE LEDERLE LABORATORIES 293978 / 2 LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Injection site reaction, INJECT SITE REACT

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) OK9011

Write-up: Local reaction.


Changed on 8/31/2010

VAERS ID: 27404 Before After
VAERS Form:
Age:66.6
Sex:Female
Location:Oklahoma
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1991-01-10
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11217 / 1 RA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 293978 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OK9011

Write-up: Local reaction.


Changed on 7/7/2013

VAERS ID: 27404 Before After
VAERS Form:
Age:66.6
Sex:Female
Location:Oklahoma
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1991-01-10
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11217 / 1 RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11217 / 1 RA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 293978 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OK9011

Write-up: Local reaction.


Changed on 2/14/2017

VAERS ID: 27404 Before After
VAERS Form:
Age:66.6 66.0
Sex:Female
Location:Oklahoma
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1991-01-10
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11217 / 1 RA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 293978 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OK9011

Write-up: Local reaction.


Changed on 5/14/2017

VAERS ID: 27404 Before After
VAERS Form:
Age:66.0
Sex:Female
Location:Oklahoma
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1991-01-10
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11217 / 1 RA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 293978 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OK9011

Write-up: Local reaction.


Changed on 9/14/2017

VAERS ID: 27404 Before After
VAERS Form:(blank) 1
Age:66.0
Sex:Female
Location:Oklahoma
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1991-01-10
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11217 / 1 2 RA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 293978 / 2 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OK9011

Write-up: Local reaction.


Changed on 2/14/2018

VAERS ID: 27404 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:Oklahoma
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1991-01-10
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11217 / 2 RA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 293978 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OK9011

Write-up: Local reaction.


Changed on 6/14/2018

VAERS ID: 27404 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:Oklahoma
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1991-01-10
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11217 / 2 RA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 293978 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OK9011

Write-up: Local reaction.


Changed on 8/14/2018

VAERS ID: 27404 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:Oklahoma
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1991-01-10
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11217 / 2 RA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 293978 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OK9011

Write-up: Local reaction.


Changed on 9/14/2018

VAERS ID: 27404 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:Oklahoma
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1991-01-10
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11217 / 2 RA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 293978 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OK9011

Write-up: Local reaction.


Changed on 10/14/2018

VAERS ID: 27404 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:Oklahoma
Vaccinated:1990-11-02
Onset:1990-11-02
Submitted:1991-01-10
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11217 / 2 RA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 293978 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Injection site reaction

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OK9011

Write-up: Local reaction.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=27404&WAYBACKHISTORY=ON


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