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This is VAERS ID 28572

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28572
VAERS Form:
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1989-1990 / CONNAUGHT LABS 0J11163 / - A / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: HYPERTONIA, EDEMA, VASODILAT

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type':

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 12/8/2009

VAERS ID: 28572 Before After
VAERS Form:
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-04-09 1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1989-1990 INFLUENZA (SEASONAL) (FLUZONE 89-90) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0J11163 / - A / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation, HYPERTONIA, EDEMA, VASODILAT

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': (blank) CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 8/31/2010

VAERS ID: 28572 Before After
VAERS Form:
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 89-90) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / - A / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 7/7/2013

VAERS ID: 28572 Before After
VAERS Form:
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / - A / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / - A / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 5/14/2017

VAERS ID: 28572 Before After
VAERS Form:
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / - A - / - A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 9/14/2017

VAERS ID: 28572 Before After
VAERS Form:(blank) 1
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / - UNK - / A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 2/14/2018

VAERS ID: 28572 Before After
VAERS Form:1
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / UNK - / A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 6/14/2018

VAERS ID: 28572 Before After
VAERS Form:1
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / UNK - / A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 8/14/2018

VAERS ID: 28572 Before After
VAERS Form:1
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / UNK - / A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 9/14/2018

VAERS ID: 28572 Before After
VAERS Form:1
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / UNK - / A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 10/14/2018

VAERS ID: 28572 Before After
VAERS Form:1
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / UNK - / A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 12/24/2020

VAERS ID: 28572 Before After
VAERS Form:1
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / UNK - / A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 12/30/2020

VAERS ID: 28572 Before After
VAERS Form:1
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / UNK - / A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 5/7/2021

VAERS ID: 28572 Before After
VAERS Form:1
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / UNK - / A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;


Changed on 5/14/2021

VAERS ID: 28572 Before After
VAERS Form:1
Age:52.0
Sex:Female
Location:Montana
Vaccinated:0000-00-00
Onset:1990-11-14
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11163 / UNK - / A

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypertonia, Oedema, Vasodilatation

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:
Current Illness:
Preexisting Conditions: not available
Allergies:
Diagnostic Lab Data: not available
CDC 'Split Type': CO3723

Write-up: Arm hot to touch, muscle stiffness & swelling; No tx to date; Had flu shot 5 yrs ago w/similar rxn; Pt stated she could not raise her arm laterally for over a year;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=28572&WAYBACKHISTORY=ON

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