National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 30720

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30720
VAERS Form:
Age:69.0
Sex:Female
Location:Florida
Vaccinated:1990-10-01
Onset:1991-02-15
Submitted:1991-05-16
Entered:1991-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS - / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, INFECT, HEADACHE, LUNG DIS, HYPOXIA

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: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pos IgGtiter for Inf A, High Titer for IgG for inf B, pos Igm for infB mycoplasma neg
CDC 'Split Type':

Write-up: Acute Resp infect, pulmonary infiltrates, hypoxemia reported in pt receiving FLUOGEN; Approx 15FEB91 hosp for acute resp infect accompanied by fever, myalgia, ha/ & sputum initially not purulent; d/c p/11days & was well 2.5 wks later;


Changed on 12/8/2009

VAERS ID: 30720 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:Florida
Vaccinated:1990-10-01
Onset:1991-02-15
Submitted:1991-05-16
Entered:1991-05-24 1991-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS - / - - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Headache, Hypoxia, Infection, Lung disorder, Myalgia, Pyrexia, Respiratory disorder, FEVER, INFECT, HEADACHE, LUNG DIS, HYPOXIA

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: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pos IgGtiter for Inf A, High Titer for IgG for inf B, pos Igm for infB mycoplasma neg
CDC 'Split Type': (blank) 914090047

Write-up: Acute Resp infect, pulmonary infiltrates, hypoxemia reported in pt receiving FLUOGEN; Approx 15FEB91 hosp for acute resp infect accompanied by fever, myalgia, ha/ & sputum initially not purulent; d/c p/11days & was well 2.5 wks later;


Changed on 8/31/2010

VAERS ID: 30720 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:Florida
Vaccinated:1990-10-01
Onset:1991-02-15
Submitted:1991-05-16
Entered:1991-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Hypoxia, Infection, Lung disorder, Myalgia, Pyrexia, Respiratory disorder

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: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pos IgGtiter for Inf A, High Titer for IgG for inf B, pos Igm for infB mycoplasma neg
CDC 'Split Type': 914090047

Write-up: Acute Resp infect, pulmonary infiltrates, hypoxemia reported in pt receiving FLUOGEN; Approx 15FEB91 hosp for acute resp infect accompanied by fever, myalgia, ha/ & sputum initially not purulent; d/c p/11days & was well 2.5 wks later;


Changed on 7/7/2013

VAERS ID: 30720 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:Florida
Vaccinated:1990-10-01
Onset:1991-02-15
Submitted:1991-05-16
Entered:1991-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Hypoxia, Infection, Lung disorder, Myalgia, Pyrexia, Respiratory disorder

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: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pos IgGtiter for Inf A, High Titer for IgG for inf B, pos Igm for infB mycoplasma neg
CDC 'Split Type': 914090047

Write-up: Acute Resp infect, pulmonary infiltrates, hypoxemia reported in pt receiving FLUOGEN; Approx 15FEB91 hosp for acute resp infect accompanied by fever, myalgia, ha/ & sputum initially not purulent; d/c p/11days & was well 2.5 wks later;


Changed on 5/14/2017

VAERS ID: 30720 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:Florida
Vaccinated:1990-10-01
Onset:1991-02-15
Submitted:1991-05-16
Entered:1991-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Hypoxia, Infection, Lung disorder, Myalgia, Pyrexia, Respiratory disorder

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: 11     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pos IgGtiter for Inf A, High Titer for IgG for inf B, pos Igm for infB mycoplasma neg
CDC 'Split Type': 914090047

Write-up: Acute Resp infect, pulmonary infiltrates, hypoxemia reported in pt receiving FLUOGEN; Approx 15FEB91 hosp for acute resp infect accompanied by fever, myalgia, ha/ & sputum initially not purulent; d/c p/11days & was well 2.5 wks later;


Changed on 9/14/2017

VAERS ID: 30720 Before After
VAERS Form:(blank) 1
Age:69.0
Sex:Female
Location:Florida
Vaccinated:1990-10-01
Onset:1991-02-15
Submitted:1991-05-16
Entered:1991-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Hypoxia, Infection, Lung disorder, Myalgia, Pyrexia, Respiratory disorder

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: 11     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pos IgGtiter for Inf A, High Titer for IgG for inf B, pos Igm for infB mycoplasma neg
CDC 'Split Type': 914090047

Write-up: Acute Resp infect, pulmonary infiltrates, hypoxemia reported in pt receiving FLUOGEN; Approx 15FEB91 hosp for acute resp infect accompanied by fever, myalgia, ha/ & sputum initially not purulent; d/c p/11days & was well 2.5 wks later;


Changed on 2/14/2018

VAERS ID: 30720 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Florida
Vaccinated:1990-10-01
Onset:1991-02-15
Submitted:1991-05-16
Entered:1991-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Hypoxia, Infection, Lung disorder, Myalgia, Pyrexia, Respiratory disorder

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: 11     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pos IgGtiter for Inf A, High Titer for IgG for inf B, pos Igm for infB mycoplasma neg
CDC 'Split Type': 914090047

Write-up: Acute Resp infect, pulmonary infiltrates, hypoxemia reported in pt receiving FLUOGEN; Approx 15FEB91 hosp for acute resp infect accompanied by fever, myalgia, ha/ & sputum initially not purulent; d/c p/11days & was well 2.5 wks later;


Changed on 6/14/2018

VAERS ID: 30720 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Florida
Vaccinated:1990-10-01
Onset:1991-02-15
Submitted:1991-05-16
Entered:1991-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Hypoxia, Infection, Lung disorder, Myalgia, Pyrexia, Respiratory disorder

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: 11     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pos IgGtiter for Inf A, High Titer for IgG for inf B, pos Igm for infB mycoplasma neg
CDC 'Split Type': 914090047

Write-up: Acute Resp infect, pulmonary infiltrates, hypoxemia reported in pt receiving FLUOGEN; Approx 15FEB91 hosp for acute resp infect accompanied by fever, myalgia, ha/ & sputum initially not purulent; d/c p/11days & was well 2.5 wks later;


Changed on 8/14/2018

VAERS ID: 30720 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Florida
Vaccinated:1990-10-01
Onset:1991-02-15
Submitted:1991-05-16
Entered:1991-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Hypoxia, Infection, Lung disorder, Myalgia, Pyrexia, Respiratory disorder

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: 11     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pos IgGtiter for Inf A, High Titer for IgG for inf B, pos Igm for infB mycoplasma neg
CDC 'Split Type': 914090047

Write-up: Acute Resp infect, pulmonary infiltrates, hypoxemia reported in pt receiving FLUOGEN; Approx 15FEB91 hosp for acute resp infect accompanied by fever, myalgia, ha/ & sputum initially not purulent; d/c p/11days & was well 2.5 wks later;


Changed on 9/14/2018

VAERS ID: 30720 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Florida
Vaccinated:1990-10-01
Onset:1991-02-15
Submitted:1991-05-16
Entered:1991-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Hypoxia, Infection, Lung disorder, Myalgia, Pyrexia, Respiratory disorder

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: 11     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pos IgGtiter for Inf A, High Titer for IgG for inf B, pos Igm for infB mycoplasma neg
CDC 'Split Type': 914090047

Write-up: Acute Resp infect, pulmonary infiltrates, hypoxemia reported in pt receiving FLUOGEN; Approx 15FEB91 hosp for acute resp infect accompanied by fever, myalgia, ha/ & sputum initially not purulent; d/c p/11days & was well 2.5 wks later;


Changed on 10/14/2018

VAERS ID: 30720 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Florida
Vaccinated:1990-10-01
Onset:1991-02-15
Submitted:1991-05-16
Entered:1991-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Hypoxia, Infection, Lung disorder, Myalgia, Pyrexia, Respiratory disorder

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: 11     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pos IgGtiter for Inf A, High Titer for IgG for inf B, pos Igm for infB mycoplasma neg
CDC 'Split Type': 914090047

Write-up: Acute Resp infect, pulmonary infiltrates, hypoxemia reported in pt receiving FLUOGEN; Approx 15FEB91 hosp for acute resp infect accompanied by fever, myalgia, ha/ & sputum initially not purulent; d/c p/11days & was well 2.5 wks later;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=30720&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166