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This is VAERS ID 36249

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36249
VAERS Form:
Age:62.4
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918201 / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: DIZZINESS, TACHYCARDIA, PHARYNGITIS, FIBRILLAT VENT

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;


Changed on 12/8/2009

VAERS ID: 36249 Before After
VAERS Form:
Age:62.4
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-26 1991-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918201 / - LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Dizziness, Pharyngitis, Tachycardia, Ventricular fibrillation, DIZZINESS, TACHYCARDIA, PHARYNGITIS, FIBRILLAT VENT

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) TN91209

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;


Changed on 8/31/2010

VAERS ID: 36249 Before After
VAERS Form:
Age:62.4
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918201 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dizziness, Pharyngitis, Tachycardia, Ventricular fibrillation

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN91209

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;


Changed on 7/7/2013

VAERS ID: 36249 Before After
VAERS Form:
Age:62.4
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918201 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918201 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dizziness, Pharyngitis, Tachycardia, Ventricular fibrillation

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN91209

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;


Changed on 12/14/2016

VAERS ID: 36249 Before After
VAERS Form:
Age:62.4
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918201 / - LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918201 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dizziness, Pharyngitis, Tachycardia, Ventricular fibrillation

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN91209

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;


Changed on 2/14/2017

VAERS ID: 36249 Before After
VAERS Form:
Age:62.4 62.0
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918201 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dizziness, Pharyngitis, Tachycardia, Ventricular fibrillation

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN91209

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;


Changed on 5/14/2017

VAERS ID: 36249 Before After
VAERS Form:
Age:62.0
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918201 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dizziness, Pharyngitis, Tachycardia, Ventricular fibrillation

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN91209

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;


Changed on 9/14/2017

VAERS ID: 36249 Before After
VAERS Form:(blank) 1
Age:62.0
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918201 / - UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dizziness, Pharyngitis, Tachycardia, Ventricular fibrillation

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN91209

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;


Changed on 2/14/2018

VAERS ID: 36249 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918201 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dizziness, Pharyngitis, Tachycardia, Ventricular fibrillation

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN91209

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;


Changed on 6/14/2018

VAERS ID: 36249 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918201 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dizziness, Pharyngitis, Tachycardia, Ventricular fibrillation

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN91209

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;


Changed on 8/14/2018

VAERS ID: 36249 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918201 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dizziness, Pharyngitis, Tachycardia, Ventricular fibrillation

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN91209

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;


Changed on 9/14/2018

VAERS ID: 36249 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918201 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dizziness, Pharyngitis, Tachycardia, Ventricular fibrillation

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN91209

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;


Changed on 10/14/2018

VAERS ID: 36249 Before After
VAERS Form:1
Age:62.0
Sex:Male
Location:Tennessee
Vaccinated:1991-10-31
Onset:1991-10-31
Submitted:1991-11-04
Entered:1991-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918201 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dizziness, Pharyngitis, Tachycardia, Ventricular fibrillation

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN91209

Write-up: 20 minutes p/immun felt faint that night felt like throat was closing; pt monitors blood pressure monitoring device seemed to go wild; heart beat was fast-160 beats a minutes; fibrillation;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=36249&WAYBACKHISTORY=ON


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