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This is VAERS ID 36019

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36019
VAERS Form:
Age:65.4
Sex:Male
Location:West Virginia
Vaccinated:1991-09-22
Onset:1991-09-26
Submitted:1991-10-10
Entered:1991-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 / PARKE-DAVIS 010171P / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: DYSPNEA, MALAISE

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: Theodur, Brethine
Current Illness: NONE
Preexisting Conditions: asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;

Write-up: Pt recvd vax 22SEP91 c/o vague malaise beginning 25SEP but not enough discomfort to interfere w/daily activities; 26SEP91 @ home 5AM severe episodes of respiratory difficulty p/3 home ventilation treatments pt drove self to hosp ER;


Changed on 12/8/2009

VAERS ID: 36019 Before After
VAERS Form:
Age:65.4
Sex:Male
Location:West Virginia
Vaccinated:1991-09-22
Onset:1991-09-26
Submitted:1991-10-10
Entered:1991-11-11 1991-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 INFLUENZA (SEASONAL) (FLUOGEN 91-92) / PARKE-DAVIS 010171P / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Dyspnoea, Malaise, DYSPNEA, MALAISE

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: Theodur, Brethine
Current Illness: NONE
Preexisting Conditions: asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago; WV9140

Write-up: Pt recvd vax 22SEP91 c/o vague malaise beginning 25SEP but not enough discomfort to interfere w/daily activities; 26SEP91 @ home 5AM severe episodes of respiratory difficulty p/3 home ventilation treatments pt drove self to hosp ER;


Changed on 8/31/2010

VAERS ID: 36019 Before After
VAERS Form:
Age:65.4
Sex:Male
Location:West Virginia
Vaccinated:1991-09-22
Onset:1991-09-26
Submitted:1991-10-10
Entered:1991-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 91-92) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 010171P / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Dyspnoea, Malaise

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: Theodur, Brethine
Current Illness: NONE
Preexisting Conditions: asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WV9140

Write-up: Pt recvd vax 22SEP91 c/o vague malaise beginning 25SEP but not enough discomfort to interfere w/daily activities; 26SEP91 @ home 5AM severe episodes of respiratory difficulty p/3 home ventilation treatments pt drove self to hosp ER;


Changed on 7/7/2013

VAERS ID: 36019 Before After
VAERS Form:
Age:65.4
Sex:Male
Location:West Virginia
Vaccinated:1991-09-22
Onset:1991-09-26
Submitted:1991-10-10
Entered:1991-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 010171P / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 010171P / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Dyspnoea, Malaise

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: Theodur, Brethine
Current Illness: NONE
Preexisting Conditions: asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WV9140

Write-up: Pt recvd vax 22SEP91 c/o vague malaise beginning 25SEP but not enough discomfort to interfere w/daily activities; 26SEP91 @ home 5AM severe episodes of respiratory difficulty p/3 home ventilation treatments pt drove self to hosp ER;


Changed on 2/14/2017

VAERS ID: 36019 Before After
VAERS Form:
Age:65.4 65.0
Sex:Male
Location:West Virginia
Vaccinated:1991-09-22
Onset:1991-09-26
Submitted:1991-10-10
Entered:1991-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 010171P / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Dyspnoea, Malaise

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: Theodur, Brethine
Current Illness: NONE
Preexisting Conditions: asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WV9140

Write-up: Pt recvd vax 22SEP91 c/o vague malaise beginning 25SEP but not enough discomfort to interfere w/daily activities; 26SEP91 @ home 5AM severe episodes of respiratory difficulty p/3 home ventilation treatments pt drove self to hosp ER;


Changed on 5/14/2017

VAERS ID: 36019 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:West Virginia
Vaccinated:1991-09-22
Onset:1991-09-26
Submitted:1991-10-10
Entered:1991-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 010171P / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Dyspnoea, Malaise

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NA NA~ ()~~~In patient
Other Medications: Theodur, Brethine
Current Illness: NONE
Preexisting Conditions: asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WV9140

Write-up: Pt recvd vax 22SEP91 c/o vague malaise beginning 25SEP but not enough discomfort to interfere w/daily activities; 26SEP91 @ home 5AM severe episodes of respiratory difficulty p/3 home ventilation treatments pt drove self to hosp ER;


Changed on 9/14/2017

VAERS ID: 36019 Before After
VAERS Form:(blank) 1
Age:65.0
Sex:Male
Location:West Virginia
Vaccinated:1991-09-22
Onset:1991-09-26
Submitted:1991-10-10
Entered:1991-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 010171P / - UNK LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Dyspnoea, Malaise

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Theodur, Brethine
Current Illness: NONE
Preexisting Conditions: asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WV9140

Write-up: Pt recvd vax 22SEP91 c/o vague malaise beginning 25SEP but not enough discomfort to interfere w/daily activities; 26SEP91 @ home 5AM severe episodes of respiratory difficulty p/3 home ventilation treatments pt drove self to hosp ER;


Changed on 2/14/2018

VAERS ID: 36019 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:West Virginia
Vaccinated:1991-09-22
Onset:1991-09-26
Submitted:1991-10-10
Entered:1991-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 010171P / UNK LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Dyspnoea, Malaise

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Theodur, Brethine
Current Illness: NONE
Preexisting Conditions: asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WV9140

Write-up: Pt recvd vax 22SEP91 c/o vague malaise beginning 25SEP but not enough discomfort to interfere w/daily activities; 26SEP91 @ home 5AM severe episodes of respiratory difficulty p/3 home ventilation treatments pt drove self to hosp ER;


Changed on 6/14/2018

VAERS ID: 36019 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:West Virginia
Vaccinated:1991-09-22
Onset:1991-09-26
Submitted:1991-10-10
Entered:1991-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 010171P / UNK LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Dyspnoea, Malaise

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Theodur, Brethine
Current Illness: NONE
Preexisting Conditions: asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WV9140

Write-up: Pt recvd vax 22SEP91 c/o vague malaise beginning 25SEP but not enough discomfort to interfere w/daily activities; 26SEP91 @ home 5AM severe episodes of respiratory difficulty p/3 home ventilation treatments pt drove self to hosp ER;


Changed on 8/14/2018

VAERS ID: 36019 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:West Virginia
Vaccinated:1991-09-22
Onset:1991-09-26
Submitted:1991-10-10
Entered:1991-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 010171P / UNK LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Dyspnoea, Malaise

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Theodur, Brethine
Current Illness: NONE
Preexisting Conditions: asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WV9140

Write-up: Pt recvd vax 22SEP91 c/o vague malaise beginning 25SEP but not enough discomfort to interfere w/daily activities; 26SEP91 @ home 5AM severe episodes of respiratory difficulty p/3 home ventilation treatments pt drove self to hosp ER;


Changed on 9/14/2018

VAERS ID: 36019 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:West Virginia
Vaccinated:1991-09-22
Onset:1991-09-26
Submitted:1991-10-10
Entered:1991-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 010171P / UNK LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Dyspnoea, Malaise

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Theodur, Brethine
Current Illness: NONE
Preexisting Conditions: asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WV9140

Write-up: Pt recvd vax 22SEP91 c/o vague malaise beginning 25SEP but not enough discomfort to interfere w/daily activities; 26SEP91 @ home 5AM severe episodes of respiratory difficulty p/3 home ventilation treatments pt drove self to hosp ER;


Changed on 10/14/2018

VAERS ID: 36019 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:West Virginia
Vaccinated:1991-09-22
Onset:1991-09-26
Submitted:1991-10-10
Entered:1991-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 010171P / UNK LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Dyspnoea, Malaise

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Theodur, Brethine
Current Illness: NONE
Preexisting Conditions: asthmatic-took allergy inject for dust, mold for about 18 months, recent testing-med d/c 3 mos ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WV9140

Write-up: Pt recvd vax 22SEP91 c/o vague malaise beginning 25SEP but not enough discomfort to interfere w/daily activities; 26SEP91 @ home 5AM severe episodes of respiratory difficulty p/3 home ventilation treatments pt drove self to hosp ER;

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