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This is VAERS ID 28835

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28835
VAERS Form:
Age:70.2
Sex:Female
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-24
Submitted:1990-11-07
Entered:1991-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 02580P / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: CHILLS, ARTHRITIS, ARTHRALGIA, DEHYDRAT, COMA

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC 'Split Type':

Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug


Changed on 12/8/2009

VAERS ID: 28835 Before After
VAERS Form:
Age:70.2
Sex:Female
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-24
Submitted:1990-11-07
Entered:1991-03-13 1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS 02580P / - LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Arthralgia, Arthritis, Chills, Coma, Dehydration, Injection site reaction, Palpitations, Pyrexia, Rash, Syncope, Vomiting, CHILLS, ARTHRITIS, ARTHRALGIA, DEHYDRAT, COMA

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC 'Split Type': (blank) MD91006

Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug


Changed on 8/31/2010

VAERS ID: 28835 Before After
VAERS Form:
Age:70.2
Sex:Female
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-24
Submitted:1990-11-07
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arthralgia, Arthritis, Chills, Coma, Dehydration, Injection site reaction, Palpitations, Pyrexia, Rash, Syncope, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC 'Split Type': MD91006

Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug


Changed on 7/7/2013

VAERS ID: 28835 Before After
VAERS Form:
Age:70.2
Sex:Female
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-24
Submitted:1990-11-07
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arthralgia, Arthritis, Chills, Coma, Dehydration, Injection site reaction, Palpitations, Pyrexia, Rash, Syncope, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC 'Split Type': MD91006

Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug


Changed on 2/14/2017

VAERS ID: 28835 Before After
VAERS Form:
Age:70.2 70.0
Sex:Female
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-24
Submitted:1990-11-07
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arthralgia, Arthritis, Chills, Coma, Dehydration, Injection site reaction, Palpitations, Pyrexia, Rash, Syncope, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC 'Split Type': MD91006

Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug


Changed on 5/14/2017

VAERS ID: 28835 Before After
VAERS Form:
Age:70.0
Sex:Female
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-24
Submitted:1990-11-07
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arthralgia, Arthritis, Chills, Coma, Dehydration, Injection site reaction, Palpitations, Pyrexia, Rash, Syncope, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC 'Split Type': MD91006

Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug


Changed on 9/14/2017

VAERS ID: 28835 Before After
VAERS Form:(blank) 1
Age:70.0
Sex:Female
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-24
Submitted:1990-11-07
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / - UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arthralgia, Arthritis, Chills, Coma, Dehydration, Injection site reaction, Palpitations, Pyrexia, Rash, Syncope, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC 'Split Type': MD91006

Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug


Changed on 2/14/2018

VAERS ID: 28835 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-24
Submitted:1990-11-07
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arthralgia, Arthritis, Chills, Coma, Dehydration, Injection site reaction, Palpitations, Pyrexia, Rash, Syncope, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC 'Split Type': MD91006

Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug


Changed on 6/14/2018

VAERS ID: 28835 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-24
Submitted:1990-11-07
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arthralgia, Arthritis, Chills, Coma, Dehydration, Injection site reaction, Palpitations, Pyrexia, Rash, Syncope, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC 'Split Type': MD91006

Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug


Changed on 8/14/2018

VAERS ID: 28835 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-24
Submitted:1990-11-07
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arthralgia, Arthritis, Chills, Coma, Dehydration, Injection site reaction, Palpitations, Pyrexia, Rash, Syncope, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC 'Split Type': MD91006

Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug


Changed on 9/14/2018

VAERS ID: 28835 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-24
Submitted:1990-11-07
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arthralgia, Arthritis, Chills, Coma, Dehydration, Injection site reaction, Palpitations, Pyrexia, Rash, Syncope, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC 'Split Type': MD91006

Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug


Changed on 10/14/2018

VAERS ID: 28835 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Maryland
Vaccinated:1990-10-02
Onset:1990-10-24
Submitted:1990-11-07
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Arthralgia, Arthritis, Chills, Coma, Dehydration, Injection site reaction, Palpitations, Pyrexia, Rash, Syncope, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: B/P 145/89
CDC 'Split Type': MD91006

Write-up: local rxn lt deltoid, rash, T 103 F,B/P-145/89,fainted 26Oct,pain in joints,inflammation of joints,vomiting,dehydration,chills,coma or marked alt in level of consciousness,heart palpitations & rash,12Oct prior to vax bug on body(tick/bedbug

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