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This is VAERS ID 30243

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30243
VAERS Form:
Age:60.6
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908181 / 0 A / -

Administered by: Private      Purchased by: Unknown
Symptoms: VOMIT

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


Changed on 12/8/2009

VAERS ID: 30243 Before After
VAERS Form:
Age:60.6
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-05-08 1991-04-29
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 4908181 / 0 A / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Vomiting, VOMIT

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


Changed on 8/31/2010

VAERS ID: 30243 Before After
VAERS Form:
Age:60.6
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908181 / 0 A / -

Administered by: Private      Purchased by: Private
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


Changed on 7/7/2013

VAERS ID: 30243 Before After
VAERS Form:
Age:60.6
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 0 A / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 0 A / -

Administered by: Private      Purchased by: Private
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


Changed on 12/14/2016

VAERS ID: 30243 Before After
VAERS Form:
Age:60.6
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 0 A / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 0 A / -

Administered by: Private      Purchased by: Private
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


Changed on 2/14/2017

VAERS ID: 30243 Before After
VAERS Form:
Age:60.6 60.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 0 A / -

Administered by: Private      Purchased by: Private
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


Changed on 5/14/2017

VAERS ID: 30243 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 0 A - / - A

Administered by: Private      Purchased by: Private
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


Changed on 9/14/2017

VAERS ID: 30243 Before After
VAERS Form:(blank) 1
Age:60.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 0 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


Changed on 2/14/2018

VAERS ID: 30243 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


Changed on 6/14/2018

VAERS ID: 30243 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


Changed on 8/14/2018

VAERS ID: 30243 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


Changed on 9/14/2018

VAERS ID: 30243 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids


Changed on 10/14/2018

VAERS ID: 30243 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-25
Onset:1990-11-01
Submitted:1991-04-05
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908181 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none specified
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891099002B

Write-up: Vomiting; pt, a MD, experienced severe vomiting p/receiving Influenza Virus Vax; Pt was hospitalized & tx IV fluids

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