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This is VAERS ID 29350

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29350
VAERS Form:
Age:66.7
Sex:Female
Location:Colorado
Vaccinated:1990-11-07
Onset:1990-11-10
Submitted:1991-03-22
Entered:1991-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 025808 / 3 A / -

Administered by: Private      Purchased by: Unknown
Symptoms: ENCEPHALITIS

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? Yes, days: 49     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC 'Split Type':

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to ""flu shot"";


Changed on 12/8/2009

VAERS ID: 29350 Before After
VAERS Form:
Age:66.7
Sex:Female
Location:Colorado
Vaccinated:1990-11-07
Onset:1990-11-10
Submitted:1991-03-22
Entered:1991-03-29 1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS 025808 / 3 A / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Encephalitis, ENCEPHALITIS

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? Yes, days: 49     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC 'Split Type':

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to ""flu shot""; "flu shot";


Changed on 8/31/2010

VAERS ID: 29350 Before After
VAERS Form:
Age:66.7
Sex:Female
Location:Colorado
Vaccinated:1990-11-07
Onset:1990-11-10
Submitted:1991-03-22
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 025808 / 3 A / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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? Yes, days: 49     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC 'Split Type':

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to "flu shot";


Changed on 7/7/2013

VAERS ID: 29350 Before After
VAERS Form:
Age:66.7
Sex:Female
Location:Colorado
Vaccinated:1990-11-07
Onset:1990-11-10
Submitted:1991-03-22
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 025808 / 3 A / -
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 025808 / 3 A / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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? Yes, days: 49     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC 'Split Type':

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to "flu shot";


Changed on 2/14/2017

VAERS ID: 29350 Before After
VAERS Form:
Age:66.7 66.0
Sex:Female
Location:Colorado
Vaccinated:1990-11-07
Onset:1990-11-10
Submitted:1991-03-22
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 025808 / 3 A / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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? Yes, days: 49     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC 'Split Type':

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to "flu shot";


Changed on 5/14/2017

VAERS ID: 29350 Before After
VAERS Form:
Age:66.0
Sex:Female
Location:Colorado
Vaccinated:1990-11-07
Onset:1990-11-10
Submitted:1991-03-22
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 025808 / 3 A - / - A

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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? Yes, days: 49     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC 'Split Type':

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to "flu shot";


Changed on 9/14/2017

VAERS ID: 29350 Before After
VAERS Form:(blank) 1
Age:66.0
Sex:Female
Location:Colorado
Vaccinated:1990-11-07
Onset:1990-11-10
Submitted:1991-03-22
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 025808 / 3 4 - / A

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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? Yes, days: 49     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC 'Split Type':

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to "flu shot";


Changed on 2/14/2018

VAERS ID: 29350 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:Colorado
Vaccinated:1990-11-07
Onset:1990-11-10
Submitted:1991-03-22
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 025808 / 4 - / A

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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? Yes, days: 49     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC 'Split Type':

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to "flu shot";


Changed on 6/14/2018

VAERS ID: 29350 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:Colorado
Vaccinated:1990-11-07
Onset:1990-11-10
Submitted:1991-03-22
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 025808 / 4 - / A

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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? Yes, days: 49     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC 'Split Type':

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to "flu shot";


Changed on 8/14/2018

VAERS ID: 29350 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:Colorado
Vaccinated:1990-11-07
Onset:1990-11-10
Submitted:1991-03-22
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 025808 / 4 - / A

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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? Yes, days: 49     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC 'Split Type':

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to "flu shot";


Changed on 9/14/2018

VAERS ID: 29350 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:Colorado
Vaccinated:1990-11-07
Onset:1990-11-10
Submitted:1991-03-22
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 025808 / 4 - / A

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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? Yes, days: 49     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC 'Split Type':

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to "flu shot";


Changed on 10/14/2018

VAERS ID: 29350 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:Colorado
Vaccinated:1990-11-07
Onset:1990-11-10
Submitted:1991-03-22
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 025808 / 4 - / A

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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? Yes, days: 49     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dyazide
Current Illness: NONE
Preexisting Conditions: Hypertension, mild
Allergies:
Diagnostic Lab Data: MRI & convalescent serum consistent
CDC 'Split Type':

Write-up: Three days p/flu shot was given, pt came down w/what was consistent w/Herpes encephalitis; Autopsy also consistent with Herpes; Does not think encephalitis was related to "flu shot";

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