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This is VAERS ID 28578

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28578
VAERS Form:
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1989-1990 / CONNAUGHT LABS - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: URTICARIA

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 12/8/2009

VAERS ID: 28578 Before After
VAERS Form:
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
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 - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria, URTICARIA

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': (blank) CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 8/31/2010

VAERS ID: 28578 Before After
VAERS Form:
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
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 - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 7/7/2013

VAERS ID: 28578 Before After
VAERS Form:
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 5/14/2017

VAERS ID: 28578 Before After
VAERS Form:
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 9/14/2017

VAERS ID: 28578 Before After
VAERS Form:(blank) 1
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 2/14/2018

VAERS ID: 28578 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 6/14/2018

VAERS ID: 28578 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 8/14/2018

VAERS ID: 28578 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 9/14/2018

VAERS ID: 28578 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 10/14/2018

VAERS ID: 28578 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 12/24/2020

VAERS ID: 28578 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 12/30/2020

VAERS ID: 28578 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 5/7/2021

VAERS ID: 28578 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;


Changed on 5/14/2021

VAERS ID: 28578 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Unknown
Vaccinated:1989-10-17
Onset:1989-10-17
Submitted:0000-00-00
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria

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: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': CO3680

Write-up: Urticaria, mild, less tha 6 hrs duration;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=28578&WAYBACKHISTORY=ON

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