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This is VAERS ID 31633

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 31633
VAERS Form:
Age:79.2
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: PNEUMONIA

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type': COPD, hypertension, s/p lobectomy for CA of lung

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


Changed on 12/8/2009

VAERS ID: 31633 Before After
VAERS Form:
Age:79.2
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-26 1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Pneumonia, PNEUMONIA

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type': COPD, hypertension, s/p lobectomy for CA of lung

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


Changed on 10/14/2012

VAERS ID: 31633 Before After
VAERS Form:
Age:79.2
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Pneumonia

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type': COPD, hypertension, s/p lobectomy for CA of lung (blank)

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


Changed on 7/7/2013

VAERS ID: 31633 Before After
VAERS Form:
Age:79.2
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Pneumonia

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type':

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


Changed on 12/14/2016

VAERS ID: 31633 Before After
VAERS Form:
Age:79.2
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Pneumonia

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type':

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


Changed on 2/14/2017

VAERS ID: 31633 Before After
VAERS Form:
Age:79.2 79.0
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Pneumonia

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type':

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


Changed on 5/14/2017

VAERS ID: 31633 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Pneumonia

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no no~ ()~~~In Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type':

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


Changed on 9/14/2017

VAERS ID: 31633 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Pneumonia

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no~ ()~~~In Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type':

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


Changed on 2/14/2018

VAERS ID: 31633 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Pneumonia

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no~ ()~~~In Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type':

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


Changed on 6/14/2018

VAERS ID: 31633 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Pneumonia

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no~ ()~~~In Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type':

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


Changed on 8/14/2018

VAERS ID: 31633 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Pneumonia

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no~ ()~~~In Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type':

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


Changed on 9/14/2018

VAERS ID: 31633 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Pneumonia

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no~ ()~~~In Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type':

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.


Changed on 10/14/2018

VAERS ID: 31633 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-12
Onset:1990-11-18
Submitted:1991-06-12
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Pneumonia

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: 5     Extended hospital stay? Yes
Previous Vaccinations: In pt no, In brother/sister no~ ()~~~In Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: COPD, hypertension, s/p lobectomy for CA of lung
Allergies:
Diagnostic Lab Data: chest xray
CDC 'Split Type':

Write-up: Following vax in 1989 & 1990, w/in 1 wk the pt was hospitalized w/ pneumonia. Though the relationship was unclear, the pt was advised to avoid vax.

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