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This is VAERS ID 28380

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28380
VAERS Form:
Age:80.7
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908209 / 0 A / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, FLU SYND, SEPSIS, PHARYNGITIS

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 12/8/2009

VAERS ID: 28380 Before After
VAERS Form:
Age:80.7
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-26 1991-02-18
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 4908209 / 0 A / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis, FEVER, FLU SYND, SEPSIS, PHARYNGITIS

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 8/31/2010

VAERS ID: 28380 Before After
VAERS Form:
Age:80.7
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908209 / 0 A / IM

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 7/7/2013

VAERS ID: 28380 Before After
VAERS Form:
Age:80.7
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 0 A / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 0 A / IM

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 12/14/2016

VAERS ID: 28380 Before After
VAERS Form:
Age:80.7
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 0 A / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 0 A / IM

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 2/14/2017

VAERS ID: 28380 Before After
VAERS Form:
Age:80.7 80.0
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 0 A / IM

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 5/14/2017

VAERS ID: 28380 Before After
VAERS Form:
Age:80.0
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 0 A - / IM IM A

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 9/14/2017

VAERS ID: 28380 Before After
VAERS Form:(blank) 1
Age:80.0
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 0 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 2/14/2018

VAERS ID: 28380 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 6/14/2018

VAERS ID: 28380 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 8/14/2018

VAERS ID: 28380 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 9/14/2018

VAERS ID: 28380 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 10/14/2018

VAERS ID: 28380 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 12/24/2020

VAERS ID: 28380 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

Changed on 12/30/2020

VAERS ID: 28380 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Michigan
Vaccinated:1990-10-01
Onset:1990-10-10
Submitted:1991-02-06
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Pharyngitis, Pyrexia, Sepsis

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions: pt has hx of cerebrovascular accident
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 890291003B

Write-up: Pt developed flu like respiratory symptoms nine days /p receiving Flu vax(1990-91 formula).Pt was admitted to acute care facility /w a respiratory infection, sepsis, & T. F/U info,recvd 25Jan91 resulted in reclassification as a 15 day rept

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=28380&WAYBACKHISTORY=ON


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