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This is VAERS ID 28474

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28474
VAERS Form:
Age:84.3
Sex:Male
Location:Washington
Vaccinated:1991-01-25
Onset:1991-01-31
Submitted:1991-02-01
Entered:1991-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1990-1991 LEDERLE / LEDERLE 289967 / 2 LA / -

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, LEUKOCYTOSIS, ANGINA PECTORIS

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC 'Split Type': heart problem-had open heart surgery 22 yrs ago

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution


Changed on 12/8/2009

VAERS ID: 28474 Before After
VAERS Form:
Age:84.3
Sex:Male
Location:Washington
Vaccinated:1991-01-25
Onset:1991-01-31
Submitted:1991-02-01
Entered:1991-03-07 1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1990-1991 LEDERLE INFLUENZA (SEASONAL) (FLU-IMUNE 90-91) / LEDERLE LEDERLE LABORATORIES 289967 / 2 LA / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Angina pectoris, Leukocytosis, Pyrexia, FEVER, LEUKOCYTOSIS, ANGINA PECTORIS

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC 'Split Type': heart problem-had open heart surgery 22 yrs ago WA91509

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution


Changed on 8/31/2010

VAERS ID: 28474 Before After
VAERS Form:
Age:84.3
Sex:Male
Location:Washington
Vaccinated:1991-01-25
Onset:1991-01-31
Submitted:1991-02-01
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE 90-91) INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289967 / 2 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Angina pectoris, Leukocytosis, Pyrexia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC 'Split Type': WA91509

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution


Changed on 7/7/2013

VAERS ID: 28474 Before After
VAERS Form:
Age:84.3
Sex:Male
Location:Washington
Vaccinated:1991-01-25
Onset:1991-01-31
Submitted:1991-02-01
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289967 / 2 LA / -
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289967 / 2 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Angina pectoris, Leukocytosis, Pyrexia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC 'Split Type': WA91509

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution


Changed on 2/14/2017

VAERS ID: 28474 Before After
VAERS Form:
Age:84.3 84.0
Sex:Male
Location:Washington
Vaccinated:1991-01-25
Onset:1991-01-31
Submitted:1991-02-01
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289967 / 2 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Angina pectoris, Leukocytosis, Pyrexia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC 'Split Type': WA91509

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution


Changed on 5/14/2017

VAERS ID: 28474 Before After
VAERS Form:
Age:84.0
Sex:Male
Location:Washington
Vaccinated:1991-01-25
Onset:1991-01-31
Submitted:1991-02-01
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289967 / 2 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Angina pectoris, Leukocytosis, Pyrexia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none none~ ()~~~In patient
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC 'Split Type': WA91509

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution


Changed on 9/14/2017

VAERS ID: 28474 Before After
VAERS Form:(blank) 1
Age:84.0
Sex:Male
Location:Washington
Vaccinated:1991-01-25
Onset:1991-01-31
Submitted:1991-02-01
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289967 / 2 3 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Angina pectoris, Leukocytosis, Pyrexia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC 'Split Type': WA91509

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution


Changed on 2/14/2018

VAERS ID: 28474 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Washington
Vaccinated:1991-01-25
Onset:1991-01-31
Submitted:1991-02-01
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289967 / 3 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Angina pectoris, Leukocytosis, Pyrexia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC 'Split Type': WA91509

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution


Changed on 6/14/2018

VAERS ID: 28474 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Washington
Vaccinated:1991-01-25
Onset:1991-01-31
Submitted:1991-02-01
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289967 / 3 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Angina pectoris, Leukocytosis, Pyrexia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC 'Split Type': WA91509

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution


Changed on 8/14/2018

VAERS ID: 28474 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Washington
Vaccinated:1991-01-25
Onset:1991-01-31
Submitted:1991-02-01
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289967 / 3 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Angina pectoris, Leukocytosis, Pyrexia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC 'Split Type': WA91509

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution


Changed on 9/14/2018

VAERS ID: 28474 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Washington
Vaccinated:1991-01-25
Onset:1991-01-31
Submitted:1991-02-01
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289967 / 3 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Angina pectoris, Leukocytosis, Pyrexia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC 'Split Type': WA91509

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution


Changed on 10/14/2018

VAERS ID: 28474 Before After
VAERS Form:1
Age:84.0
Sex:Male
Location:Washington
Vaccinated:1991-01-25
Onset:1991-01-31
Submitted:1991-02-01
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289967 / 3 LA / -

Administered by: Public      Purchased by: Public
Symptoms: Angina pectoris, Leukocytosis, Pyrexia

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Heart meds are routinely taken
Current Illness: none
Preexisting Conditions: heart problem-had open heart surgery 22 yrs ago
Allergies:
Diagnostic Lab Data: variety-slight elevation of WBC only thing found
CDC 'Split Type': WA91509

Write-up: Daughter called to rpt her father developed T 102 & angina pains, went to ER, MD admitted pt for test @ 300 pm, Tylenol given @ 600 pm, T nl & pt feeling OK, Put on 3 days of antibiotic as a precaution

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=28474&WAYBACKHISTORY=ON


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