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This is VAERS ID 28753

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28753
VAERS Form:
Age:80.6
Sex:Male
Location:California
Vaccinated:1990-11-23
Onset:1990-11-24
Submitted:1990-11-30
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11203 / 0 RA / -

Administered by: Other      Purchased by: Unknown
Symptoms: DIZZINESS, FEVER, DYSPNEA, COUGH INC, DEPRESSION

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-29
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: Robitussin; Amoxicillin, 02, ""routine cardiac meds""
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


Changed on 12/8/2009

VAERS ID: 28753 Before After
VAERS Form:
Age:80.6
Sex:Male
Location:California
Vaccinated:1990-11-23
Onset:1990-11-24
Submitted:1990-11-30
Entered:1991-03-08 1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11203 / 0 RA / -

Administered by: Other      Purchased by: Unknown Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia, DIZZINESS, FEVER, DYSPNEA, COUGH INC, DEPRESSION

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-29
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: Robitussin; Amoxicillin, 02, ""routine "routine cardiac meds"" meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


Changed on 8/31/2010

VAERS ID: 28753 Before After
VAERS Form:
Age:80.6
Sex:Male
Location:California
Vaccinated:1990-11-23
Onset:1990-11-24
Submitted:1990-11-30
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-29
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: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


Changed on 7/7/2013

VAERS ID: 28753 Before After
VAERS Form:
Age:80.6
Sex:Male
Location:California
Vaccinated:1990-11-23
Onset:1990-11-24
Submitted:1990-11-30
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 RA / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-29
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: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


Changed on 2/14/2017

VAERS ID: 28753 Before After
VAERS Form:
Age:80.6 80.0
Sex:Male
Location:California
Vaccinated:1990-11-23
Onset:1990-11-24
Submitted:1990-11-30
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-29
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: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


Changed on 5/14/2017

VAERS ID: 28753 Before After
VAERS Form:
Age:80.0
Sex:Male
Location:California
Vaccinated:1990-11-23
Onset:1990-11-24
Submitted:1990-11-30
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-29
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: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


Changed on 9/14/2017

VAERS ID: 28753 Before After
VAERS Form:(blank) 1
Age:80.0
Sex:Male
Location:California
Vaccinated:1990-11-23
Onset:1990-11-24
Submitted:1990-11-30
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 0 1 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-29
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: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


Changed on 2/14/2018

VAERS ID: 28753 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:California
Vaccinated:1990-11-23
Onset:1990-11-24
Submitted:1990-11-30
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 1 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-29
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: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


Changed on 6/14/2018

VAERS ID: 28753 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:California
Vaccinated:1990-11-23
Onset:1990-11-24
Submitted:1990-11-30
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 1 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-29
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: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


Changed on 8/14/2018

VAERS ID: 28753 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:California
Vaccinated:1990-11-23
Onset:1990-11-24
Submitted:1990-11-30
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 1 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-29
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: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


Changed on 9/14/2018

VAERS ID: 28753 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:California
Vaccinated:1990-11-23
Onset:1990-11-24
Submitted:1990-11-30
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 1 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-29
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: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.


Changed on 10/14/2018

VAERS ID: 28753 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:California
Vaccinated:1990-11-23
Onset:1990-11-24
Submitted:1990-11-30
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11203 / 1 RA / -

Administered by: Other      Purchased by: Public
Symptoms: Cough, Depression, Dizziness, Dyspnoea, Hyperhidrosis, Pallor, Pharyngitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-11-29
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: Robitussin; Amoxicillin, 02, "routine cardiac meds"
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9130

Write-up: Began URI w/fever 24NOV90, treated w/ Robitussin. Coughing, fever & depression continued 26NOV90 rx Amoxicillin. Better & up walking 28NOV but @ 5PM was pale, dizzy, sweaty & had SOB.

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