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This is VAERS ID 31993

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 31993
VAERS Form:
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:1989-11-27
Onset:1989-12-10
Submitted:1991-06-19
Entered:1991-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 01209P / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: PERICARDITIS, ANEMIA, ATELECTASIS, THROMBOCYTOPENIA, FIBRILLAT ATR

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: 24     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec


Changed on 12/8/2009

VAERS ID: 31993 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:1989-11-27
Onset:1989-12-10
Submitted:1991-06-19
Entered:1991-07-05 1991-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS 01209P / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Anaemia, Atelectasis, Atrial fibrillation, Pericarditis, Thrombocytopenia, PERICARDITIS, ANEMIA, ATELECTASIS, THROMBOCYTOPENIA, FIBRILLAT ATR

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: 24     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) 914089002

Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec


Changed on 8/31/2010

VAERS ID: 31993 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:1989-11-27
Onset:1989-12-10
Submitted:1991-06-19
Entered:1991-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01209P / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Atelectasis, Atrial fibrillation, Pericarditis, Thrombocytopenia

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: 24     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 914089002

Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec


Changed on 7/7/2013

VAERS ID: 31993 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:1989-11-27
Onset:1989-12-10
Submitted:1991-06-19
Entered:1991-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01209P / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01209P / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Atelectasis, Atrial fibrillation, Pericarditis, Thrombocytopenia

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: 24     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 914089002

Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec


Changed on 5/14/2017

VAERS ID: 31993 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:1989-11-27
Onset:1989-12-10
Submitted:1991-06-19
Entered:1991-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01209P / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Atelectasis, Atrial fibrillation, Pericarditis, Thrombocytopenia

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: 24     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 914089002

Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec


Changed on 9/14/2017

VAERS ID: 31993 Before After
VAERS Form:(blank) 1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:1989-11-27
Onset:1989-12-10
Submitted:1991-06-19
Entered:1991-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01209P / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Atelectasis, Atrial fibrillation, Pericarditis, Thrombocytopenia

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: 24     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 914089002

Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec


Changed on 2/14/2018

VAERS ID: 31993 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:1989-11-27
Onset:1989-12-10
Submitted:1991-06-19
Entered:1991-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01209P / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Atelectasis, Atrial fibrillation, Pericarditis, Thrombocytopenia

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: 24     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 914089002

Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec


Changed on 6/14/2018

VAERS ID: 31993 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:1989-11-27
Onset:1989-12-10
Submitted:1991-06-19
Entered:1991-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01209P / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Atelectasis, Atrial fibrillation, Pericarditis, Thrombocytopenia

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: 24     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 914089002

Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec


Changed on 8/14/2018

VAERS ID: 31993 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:1989-11-27
Onset:1989-12-10
Submitted:1991-06-19
Entered:1991-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01209P / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Atelectasis, Atrial fibrillation, Pericarditis, Thrombocytopenia

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: 24     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 914089002

Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec


Changed on 9/14/2018

VAERS ID: 31993 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:1989-11-27
Onset:1989-12-10
Submitted:1991-06-19
Entered:1991-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01209P / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Atelectasis, Atrial fibrillation, Pericarditis, Thrombocytopenia

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: 24     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 914089002

Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec


Changed on 10/14/2018

VAERS ID: 31993 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:1989-11-27
Onset:1989-12-10
Submitted:1991-06-19
Entered:1991-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01209P / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Anaemia, Atelectasis, Atrial fibrillation, Pericarditis, Thrombocytopenia

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: 24     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 914089002

Write-up: Pericarditis atrial fibrillation, thrombocytopenia, anemia reported in pt receiving Fluogen; Pt recd vax 27NOV89 & on 10DEC89 was admitted to hosp w/dx of viral pericarditis & new onset atrial fibrillation; dx paroysmal atrial fib & atelec

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=31993&WAYBACKHISTORY=ON


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