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This is VAERS ID 35721

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 35721
VAERS Form:
Age:80.8
Sex:Male
Location:Oklahoma
Vaccinated:1991-10-03
Onset:1991-10-03
Submitted:1991-10-07
Entered:1991-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 1F21214 / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: CHILLS, FEVER, TREMOR

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: No;
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC 'Split Type': Diabetes; high blood pressure; heart disease;

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;


Changed on 12/8/2009

VAERS ID: 35721 Before After
VAERS Form:
Age:80.8
Sex:Male
Location:Oklahoma
Vaccinated:1991-10-03
Onset:1991-10-03
Submitted:1991-10-07
Entered:1991-10-23 1991-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1F21214 / 0 LA / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Chills, Pyrexia, Tremor, CHILLS, FEVER, TREMOR

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: No;
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC 'Split Type': Diabetes; high blood pressure; heart disease; OK9158

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;


Changed on 8/31/2010

VAERS ID: 35721 Before After
VAERS Form:
Age:80.8
Sex:Male
Location:Oklahoma
Vaccinated:1991-10-03
Onset:1991-10-03
Submitted:1991-10-07
Entered:1991-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / 0 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: No;
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC 'Split Type': OK9158

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;


Changed on 7/7/2013

VAERS ID: 35721 Before After
VAERS Form:
Age:80.8
Sex:Male
Location:Oklahoma
Vaccinated:1991-10-03
Onset:1991-10-03
Submitted:1991-10-07
Entered:1991-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / 0 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: No;
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC 'Split Type': OK9158

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;


Changed on 2/14/2017

VAERS ID: 35721 Before After
VAERS Form:
Age:80.8 80.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-10-03
Onset:1991-10-03
Submitted:1991-10-07
Entered:1991-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / 0 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: No;
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC 'Split Type': OK9158

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;


Changed on 5/14/2017

VAERS ID: 35721 Before After
VAERS Form:
Age:80.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-10-03
Onset:1991-10-03
Submitted:1991-10-07
Entered:1991-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / 0 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: No; No;~ ()~~~In patient
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC 'Split Type': OK9158

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;


Changed on 9/14/2017

VAERS ID: 35721 Before After
VAERS Form:(blank) 1
Age:80.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-10-03
Onset:1991-10-03
Submitted:1991-10-07
Entered:1991-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / 0 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: No;~ ()~~~In patient
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC 'Split Type': OK9158

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;


Changed on 2/14/2018

VAERS ID: 35721 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-10-03
Onset:1991-10-03
Submitted:1991-10-07
Entered:1991-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: No;~ ()~~~In patient
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC 'Split Type': OK9158

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;


Changed on 6/14/2018

VAERS ID: 35721 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-10-03
Onset:1991-10-03
Submitted:1991-10-07
Entered:1991-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: No;~ ()~~~In patient
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC 'Split Type': OK9158

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;


Changed on 8/14/2018

VAERS ID: 35721 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-10-03
Onset:1991-10-03
Submitted:1991-10-07
Entered:1991-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: No;~ ()~~~In patient
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC 'Split Type': OK9158

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;


Changed on 9/14/2018

VAERS ID: 35721 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-10-03
Onset:1991-10-03
Submitted:1991-10-07
Entered:1991-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: No;~ ()~~~In patient
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC 'Split Type': OK9158

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;


Changed on 10/14/2018

VAERS ID: 35721 Before After
VAERS Form:1
Age:80.0
Sex:Male
Location:Oklahoma
Vaccinated:1991-10-03
Onset:1991-10-03
Submitted:1991-10-07
Entered:1991-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21214 / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Chills, Pyrexia, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: No;~ ()~~~In patient
Other Medications: Micronase; Nitro-Bid; Lanoxin;
Current Illness: None;
Preexisting Conditions: Diabetes; high blood pressure; heart disease;
Allergies:
Diagnostic Lab Data: CBC was normal;
CDC 'Split Type': OK9158

Write-up: Approx 5 hrs p/shot Pt started chilling & shaking & temp reached 102.8; Pt was hospitalized overnight & next day felt fine;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=35721&WAYBACKHISTORY=ON


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