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This is VAERS ID 30871

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30871
VAERS Form:
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1990-1991 LEDERLE / LEDERLE 289965 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: DIARRHEA, RASH MAC PAP, PHARYNGITIS

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 12/8/2009

VAERS ID: 30871 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-06-03 1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1990-1991 LEDERLE INFLUENZA (SEASONAL) (FLU-IMUNE 90-91) / LEDERLE LEDERLE LABORATORIES 289965 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular, DIARRHEA, RASH MAC PAP, PHARYNGITIS

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': (blank) 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 8/31/2010

VAERS ID: 30871 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE 90-91) INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 7/7/2013

VAERS ID: 30871 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 5/14/2017

VAERS ID: 30871 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 9/14/2017

VAERS ID: 30871 Before After
VAERS Form:(blank) 1
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 2/14/2018

VAERS ID: 30871 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 6/14/2018

VAERS ID: 30871 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 8/14/2018

VAERS ID: 30871 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 9/14/2018

VAERS ID: 30871 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 10/14/2018

VAERS ID: 30871 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 12/24/2020

VAERS ID: 30871 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 12/30/2020

VAERS ID: 30871 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 5/7/2021

VAERS ID: 30871 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;


Changed on 5/14/2021

VAERS ID: 30871 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Massachusetts
Vaccinated:1990-11-13
Onset:1990-11-16
Submitted:0000-00-00
Entered:1991-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 289965 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Pharyngitis, Rash maculo-papular

Life Threatening? No
Birth Defect? No
Died? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No hx of local or systemic rxn, hx of rash following ampicillin;
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 900204101

Write-up: Approx 48hr p/immun, pt experienced a non-pyretic maculo papular rash over the entire body & an episode of diarrhea four hrs later; On exam had mild erythematous throat; No tx; Pt has sinus congestion 1 wk prior to immun;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=30871&WAYBACKHISTORY=ON

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