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This is VAERS ID 28836

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28836
VAERS Form:
Age:69.3
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908209 / - LA / IM
PPV: PNU-IMUNE(R)23 / LEDERLE 283923 / - RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: INJECT SITE REACT, HEADACHE

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Local rxn rt upper arm; headaches.


Changed on 12/8/2009

VAERS ID: 28836 Before After
VAERS Form:
Age:69.3
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-14 1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) / WYETH WYETH PHARMACEUTICALS, INC 4908209 / - LA / IM
PPV: PNU-IMUNE(R)23 PNEUMO (PNU-IMUNE) / LEDERLE LEDERLE LABORATORIES 283923 / - RA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Headache, Injection site reaction, INJECT SITE REACT, HEADACHE

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 8/31/2010

VAERS ID: 28836 Before After
VAERS Form:
Age:69.3
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908209 / - LA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 283923 / - RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 7/7/2013

VAERS ID: 28836 Before After
VAERS Form:
Age:69.3
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - LA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 283923 / - RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 12/14/2016

VAERS ID: 28836 Before After
VAERS Form:
Age:69.3
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - LA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 283923 / - RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 2/14/2017

VAERS ID: 28836 Before After
VAERS Form:
Age:69.3 69.0
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - LA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 283923 / - RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 5/14/2017

VAERS ID: 28836 Before After
VAERS Form:
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - LA / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 283923 / - RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 9/14/2017

VAERS ID: 28836 Before After
VAERS Form:(blank) 1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / - UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 283923 / - UNK RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 2/14/2018

VAERS ID: 28836 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 283923 / UNK RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 6/14/2018

VAERS ID: 28836 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 283923 / UNK RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 8/14/2018

VAERS ID: 28836 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 283923 / UNK RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 9/14/2018

VAERS ID: 28836 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 283923 / UNK RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 10/14/2018

VAERS ID: 28836 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 283923 / UNK RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 12/24/2020

VAERS ID: 28836 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 283923 / UNK RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 12/30/2020

VAERS ID: 28836 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 283923 / UNK RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 5/7/2021

VAERS ID: 28836 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 283923 / UNK RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.


Changed on 5/14/2021

VAERS ID: 28836 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1990-11-28
Onset:1990-11-28
Submitted:1990-11-29
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 283923 / UNK RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Headache, Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD91007

Write-up: Local rxn rt upper arm; headaches.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=28836&WAYBACKHISTORY=ON

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