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This is VAERS ID 29811

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29811
VAERS Form:
Age:73.5
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908200 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, FLU SYND, MYASTHENIA, CARCINOMA, NEURITIS PERIPH

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


Changed on 12/8/2009

VAERS ID: 29811 Before After
VAERS Form:
Age:73.5
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-15 1991-04-08
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 4908200 / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia, FEVER, FLU SYND, MYASTHENIA, CARCINOMA, NEURITIS PERIPH

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


Changed on 8/31/2010

VAERS ID: 29811 Before After
VAERS Form:
Age:73.5
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908200 / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


Changed on 7/7/2013

VAERS ID: 29811 Before After
VAERS Form:
Age:73.5
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


Changed on 12/14/2016

VAERS ID: 29811 Before After
VAERS Form:
Age:73.5
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


Changed on 2/14/2017

VAERS ID: 29811 Before After
VAERS Form:
Age:73.5 73.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


Changed on 5/14/2017

VAERS ID: 29811 Before After
VAERS Form:
Age:73.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


Changed on 9/14/2017

VAERS ID: 29811 Before After
VAERS Form:(blank) 1
Age:73.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


Changed on 2/14/2018

VAERS ID: 29811 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


Changed on 6/14/2018

VAERS ID: 29811 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


Changed on 8/14/2018

VAERS ID: 29811 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


Changed on 9/14/2018

VAERS ID: 29811 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


Changed on 10/14/2018

VAERS ID: 29811 Before After
VAERS Form:1
Age:73.0
Sex:Female
Location:California
Vaccinated:1990-10-19
Onset:1990-10-20
Submitted:1991-03-08
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;

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