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This is VAERS ID 30075

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30075
VAERS Form:
Age:67.5
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH - / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, ARTHRALGIA, LYMPHADENO, MYALGIA, LYMPHOMA LIKE REACT

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 12/8/2009

VAERS ID: 30075 Before After
VAERS Form:
Age:67.5
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-26 1991-04-22
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 - / - LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis, FEVER, ARTHRALGIA, LYMPHADENO, MYALGIA, LYMPHOMA LIKE REACT

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 8/31/2010

VAERS ID: 30075 Before After
VAERS Form:
Age:67.5
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 7/7/2013

VAERS ID: 30075 Before After
VAERS Form:
Age:67.5
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 12/14/2016

VAERS ID: 30075 Before After
VAERS Form:
Age:67.5
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 2/14/2017

VAERS ID: 30075 Before After
VAERS Form:
Age:67.5 67.0
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 5/14/2017

VAERS ID: 30075 Before After
VAERS Form:
Age:67.0
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 9/14/2017

VAERS ID: 30075 Before After
VAERS Form:(blank) 1
Age:67.0
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 2/14/2018

VAERS ID: 30075 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 6/14/2018

VAERS ID: 30075 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 8/14/2018

VAERS ID: 30075 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 9/14/2018

VAERS ID: 30075 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 10/14/2018

VAERS ID: 30075 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 12/24/2020

VAERS ID: 30075 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 12/30/2020

VAERS ID: 30075 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 5/7/2021

VAERS ID: 30075 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;


Changed on 5/14/2021

VAERS ID: 30075 Before After
VAERS Form:1
Age:67.0
Sex:Male
Location:Illinois
Vaccinated:1990-11-01
Onset:1990-11-17
Submitted:1991-01-11
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Lymphadenopathy, Myalgia, Pain, Pseudo lymphoma, Pyrexia, Rhinitis

Life Threatening? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: Pt has hx of kyphoscoliosis;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891017005B

Write-up: Pt experienced head congestion, arthralgia, swelling & tenderness of the lt axilla lymph nodes (5cm x 3cm) p/receiving Flu vax in lt deltoid; tx ASA 4 times day; Dx diffuse lymphocytic lymphoma based on tissue biopsy & bone marrow;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=30075&WAYBACKHISTORY=ON

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