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This is VAERS ID 27639

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27639
VAERS Form:
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-26
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1990-1991 LEDERLE / LEDERLE - / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: FEVER, DYSPNEA

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Bronchiectasis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 4-5 hrs after receiving Influenza vaccine, pt experienced respiratory distress & fever of 105. Hospitalized for 3 days.


Changed on 12/8/2009

VAERS ID: 27639 Before After
VAERS Form:
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-26
Entered:1991-02-01 1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1990-1991 LEDERLE INFLUENZA (SEASONAL) (FLU-IMUNE 90-91) / LEDERLE LEDERLE LABORATORIES - / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Dyspnoea, Pyrexia, FEVER, DYSPNEA

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Bronchiectasis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 910003501

Write-up: 4-5 hrs after receiving Influenza vaccine, pt experienced respiratory distress & fever of 105. Hospitalized for 3 days.


Changed on 8/31/2010

VAERS ID: 27639 Before After
VAERS Form:
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-26
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE 90-91) INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, 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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Bronchiectasis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910003501

Write-up: 4-5 hrs after receiving Influenza vaccine, pt experienced respiratory distress & fever of 105. Hospitalized for 3 days.


Changed on 7/7/2013

VAERS ID: 27639 Before After
VAERS Form:
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-26
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / - - / -
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, 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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Bronchiectasis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910003501

Write-up: 4-5 hrs after receiving Influenza vaccine, pt experienced respiratory distress & fever of 105. Hospitalized for 3 days.


Changed on 5/14/2017

VAERS ID: 27639 Before After
VAERS Form:
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-26
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, 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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Bronchiectasis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910003501

Write-up: 4-5 hrs after receiving Influenza vaccine, pt experienced respiratory distress & fever of 105. Hospitalized for 3 days.


Changed on 9/14/2017

VAERS ID: 27639 Before After
VAERS Form:(blank) 1
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-26
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / - UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, 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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Bronchiectasis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910003501

Write-up: 4-5 hrs after receiving Influenza vaccine, pt experienced respiratory distress & fever of 105. Hospitalized for 3 days.


Changed on 2/14/2018

VAERS ID: 27639 Before After
VAERS Form:1
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-26
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, 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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Bronchiectasis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910003501

Write-up: 4-5 hrs after receiving Influenza vaccine, pt experienced respiratory distress & fever of 105. Hospitalized for 3 days.


Changed on 6/14/2018

VAERS ID: 27639 Before After
VAERS Form:1
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-26
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, 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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Bronchiectasis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910003501

Write-up: 4-5 hrs after receiving Influenza vaccine, pt experienced respiratory distress & fever of 105. Hospitalized for 3 days.


Changed on 8/14/2018

VAERS ID: 27639 Before After
VAERS Form:1
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-26
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, 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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Bronchiectasis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910003501

Write-up: 4-5 hrs after receiving Influenza vaccine, pt experienced respiratory distress & fever of 105. Hospitalized for 3 days.


Changed on 9/14/2018

VAERS ID: 27639 Before After
VAERS Form:1
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-26
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, 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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Bronchiectasis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910003501

Write-up: 4-5 hrs after receiving Influenza vaccine, pt experienced respiratory distress & fever of 105. Hospitalized for 3 days.


Changed on 10/14/2018

VAERS ID: 27639 Before After
VAERS Form:1
Age:
Sex:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-26
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, 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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Bronchiectasis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910003501

Write-up: 4-5 hrs after receiving Influenza vaccine, pt experienced respiratory distress & fever of 105. Hospitalized for 3 days.

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