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This is VAERS ID 27430

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27430
VAERS Form:
Age:70.0
Sex:Female
Location:North Carolina
Vaccinated:1990-10-18
Onset:1990-10-18
Submitted:0000-00-00
Entered:1991-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: INJECT SITE REACT, FEVER

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Doxepin, Fluoxetine, Hydroxyzine
Current Illness:
Preexisting Conditions: Has received such vaccines previously without complications.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed erythematous, warm, raised area localized to site of inject. Resolved w/o significant complications. Low grade fever associated w/event. Treated w/ PO Acetaminophen & Diphenhydramine,Triamcinolone crm


Changed on 12/8/2009

VAERS ID: 27430 Before After
VAERS Form:
Age:70.0
Sex:Female
Location:North Carolina
Vaccinated:1990-10-18
Onset:1990-10-18
Submitted:0000-00-00
Entered:1991-01-17 1991-01-14
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 - / - - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Doxepin, Fluoxetine, Hydroxyzine
Current Illness:
Preexisting Conditions: Has received such vaccines previously without complications.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed erythematous, warm, raised area localized to site of inject. Resolved w/o significant complications. Low grade fever associated w/event. Treated w/ PO Acetaminophen & Diphenhydramine,Triamcinolone crm


Changed on 8/31/2010

VAERS ID: 27430 Before After
VAERS Form:
Age:70.0
Sex:Female
Location:North Carolina
Vaccinated:1990-10-18
Onset:1990-10-18
Submitted:0000-00-00
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Doxepin, Fluoxetine, Hydroxyzine
Current Illness:
Preexisting Conditions: Has received such vaccines previously without complications.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed erythematous, warm, raised area localized to site of inject. Resolved w/o significant complications. Low grade fever associated w/event. Treated w/ PO Acetaminophen & Diphenhydramine,Triamcinolone crm


Changed on 7/7/2013

VAERS ID: 27430 Before After
VAERS Form:
Age:70.0
Sex:Female
Location:North Carolina
Vaccinated:1990-10-18
Onset:1990-10-18
Submitted:0000-00-00
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Doxepin, Fluoxetine, Hydroxyzine
Current Illness:
Preexisting Conditions: Has received such vaccines previously without complications.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed erythematous, warm, raised area localized to site of inject. Resolved w/o significant complications. Low grade fever associated w/event. Treated w/ PO Acetaminophen & Diphenhydramine,Triamcinolone crm


Changed on 12/14/2016

VAERS ID: 27430 Before After
VAERS Form:
Age:70.0
Sex:Female
Location:North Carolina
Vaccinated:1990-10-18
Onset:1990-10-18
Submitted:0000-00-00
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Doxepin, Fluoxetine, Hydroxyzine
Current Illness:
Preexisting Conditions: Has received such vaccines previously without complications.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed erythematous, warm, raised area localized to site of inject. Resolved w/o significant complications. Low grade fever associated w/event. Treated w/ PO Acetaminophen & Diphenhydramine,Triamcinolone crm


Changed on 5/14/2017

VAERS ID: 27430 Before After
VAERS Form:
Age:70.0
Sex:Female
Location:North Carolina
Vaccinated:1990-10-18
Onset:1990-10-18
Submitted:0000-00-00
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Doxepin, Fluoxetine, Hydroxyzine
Current Illness:
Preexisting Conditions: Has received such vaccines previously without complications.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed erythematous, warm, raised area localized to site of inject. Resolved w/o significant complications. Low grade fever associated w/event. Treated w/ PO Acetaminophen & Diphenhydramine,Triamcinolone crm


Changed on 9/14/2017

VAERS ID: 27430 Before After
VAERS Form:(blank) 1
Age:70.0
Sex:Female
Location:North Carolina
Vaccinated:1990-10-18
Onset:1990-10-18
Submitted:0000-00-00
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Doxepin, Fluoxetine, Hydroxyzine
Current Illness:
Preexisting Conditions: Has received such vaccines previously without complications.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed erythematous, warm, raised area localized to site of inject. Resolved w/o significant complications. Low grade fever associated w/event. Treated w/ PO Acetaminophen & Diphenhydramine,Triamcinolone crm


Changed on 2/14/2018

VAERS ID: 27430 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:North Carolina
Vaccinated:1990-10-18
Onset:1990-10-18
Submitted:0000-00-00
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Doxepin, Fluoxetine, Hydroxyzine
Current Illness:
Preexisting Conditions: Has received such vaccines previously without complications.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed erythematous, warm, raised area localized to site of inject. Resolved w/o significant complications. Low grade fever associated w/event. Treated w/ PO Acetaminophen & Diphenhydramine,Triamcinolone crm


Changed on 6/14/2018

VAERS ID: 27430 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:North Carolina
Vaccinated:1990-10-18
Onset:1990-10-18
Submitted:0000-00-00
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Doxepin, Fluoxetine, Hydroxyzine
Current Illness:
Preexisting Conditions: Has received such vaccines previously without complications.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed erythematous, warm, raised area localized to site of inject. Resolved w/o significant complications. Low grade fever associated w/event. Treated w/ PO Acetaminophen & Diphenhydramine,Triamcinolone crm


Changed on 8/14/2018

VAERS ID: 27430 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:North Carolina
Vaccinated:1990-10-18
Onset:1990-10-18
Submitted:0000-00-00
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Doxepin, Fluoxetine, Hydroxyzine
Current Illness:
Preexisting Conditions: Has received such vaccines previously without complications.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed erythematous, warm, raised area localized to site of inject. Resolved w/o significant complications. Low grade fever associated w/event. Treated w/ PO Acetaminophen & Diphenhydramine,Triamcinolone crm


Changed on 9/14/2018

VAERS ID: 27430 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:North Carolina
Vaccinated:1990-10-18
Onset:1990-10-18
Submitted:0000-00-00
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Doxepin, Fluoxetine, Hydroxyzine
Current Illness:
Preexisting Conditions: Has received such vaccines previously without complications.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed erythematous, warm, raised area localized to site of inject. Resolved w/o significant complications. Low grade fever associated w/event. Treated w/ PO Acetaminophen & Diphenhydramine,Triamcinolone crm


Changed on 10/14/2018

VAERS ID: 27430 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:North Carolina
Vaccinated:1990-10-18
Onset:1990-10-18
Submitted:0000-00-00
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Doxepin, Fluoxetine, Hydroxyzine
Current Illness:
Preexisting Conditions: Has received such vaccines previously without complications.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed erythematous, warm, raised area localized to site of inject. Resolved w/o significant complications. Low grade fever associated w/event. Treated w/ PO Acetaminophen & Diphenhydramine,Triamcinolone crm

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=27430&WAYBACKHISTORY=ON


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