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This is VAERS ID 36317

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36317
VAERS Form:
Age:68.3
Sex:Male
Location:Illinois
Vaccinated:1991-10-18
Onset:1991-10-22
Submitted:1991-11-07
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1991-1992 / CONNAUGHT LABS 1F21209 / - A / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, PAIN CHEST

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC 'Split Type':

Write-up: Chest pain, fever 100;


Changed on 12/8/2009

VAERS ID: 36317 Before After
VAERS Form:
Age:68.3
Sex:Male
Location:Illinois
Vaccinated:1991-10-18
Onset:1991-10-22
Submitted:1991-11-07
Entered:1991-11-26 1991-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1991-1992 INFLUENZA (SEASONAL) (FLUZONE 91-92) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1F21209 / - A / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Chest pain, Pyrexia, FEVER, PAIN CHEST

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC 'Split Type':

Write-up: Chest pain, fever 100;


Changed on 8/31/2010

VAERS ID: 36317 Before After
VAERS Form:
Age:68.3
Sex:Male
Location:Illinois
Vaccinated:1991-10-18
Onset:1991-10-22
Submitted:1991-11-07
Entered:1991-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 91-92) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / - A / IM

Administered by: Private      Purchased by: Public
Symptoms: Chest pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC 'Split Type':

Write-up: Chest pain, fever 100;


Changed on 7/7/2013

VAERS ID: 36317 Before After
VAERS Form:
Age:68.3
Sex:Male
Location:Illinois
Vaccinated:1991-10-18
Onset:1991-10-22
Submitted:1991-11-07
Entered:1991-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / - A / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / - A / IM

Administered by: Private      Purchased by: Public
Symptoms: Chest pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC 'Split Type':

Write-up: Chest pain, fever 100;


Changed on 2/14/2017

VAERS ID: 36317 Before After
VAERS Form:
Age:68.3 68.0
Sex:Male
Location:Illinois
Vaccinated:1991-10-18
Onset:1991-10-22
Submitted:1991-11-07
Entered:1991-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / - A / IM

Administered by: Private      Purchased by: Public
Symptoms: Chest pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC 'Split Type':

Write-up: Chest pain, fever 100;


Changed on 5/14/2017

VAERS ID: 36317 Before After
VAERS Form:
Age:68.0
Sex:Male
Location:Illinois
Vaccinated:1991-10-18
Onset:1991-10-22
Submitted:1991-11-07
Entered:1991-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / - A - / IM IM A

Administered by: Private      Purchased by: Public
Symptoms: Chest pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC 'Split Type':

Write-up: Chest pain, fever 100;


Changed on 9/14/2017

VAERS ID: 36317 Before After
VAERS Form:(blank) 1
Age:68.0
Sex:Male
Location:Illinois
Vaccinated:1991-10-18
Onset:1991-10-22
Submitted:1991-11-07
Entered:1991-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / - UNK - / IM A

Administered by: Private      Purchased by: Public
Symptoms: Chest pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC 'Split Type':

Write-up: Chest pain, fever 100;


Changed on 2/14/2018

VAERS ID: 36317 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Illinois
Vaccinated:1991-10-18
Onset:1991-10-22
Submitted:1991-11-07
Entered:1991-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / UNK - / IM A

Administered by: Private      Purchased by: Public
Symptoms: Chest pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC 'Split Type':

Write-up: Chest pain, fever 100;


Changed on 6/14/2018

VAERS ID: 36317 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Illinois
Vaccinated:1991-10-18
Onset:1991-10-22
Submitted:1991-11-07
Entered:1991-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / UNK - / IM A

Administered by: Private      Purchased by: Public
Symptoms: Chest pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC 'Split Type':

Write-up: Chest pain, fever 100;


Changed on 8/14/2018

VAERS ID: 36317 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Illinois
Vaccinated:1991-10-18
Onset:1991-10-22
Submitted:1991-11-07
Entered:1991-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / UNK - / IM A

Administered by: Private      Purchased by: Public
Symptoms: Chest pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC 'Split Type':

Write-up: Chest pain, fever 100;


Changed on 9/14/2018

VAERS ID: 36317 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Illinois
Vaccinated:1991-10-18
Onset:1991-10-22
Submitted:1991-11-07
Entered:1991-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / UNK - / IM A

Administered by: Private      Purchased by: Public
Symptoms: Chest pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC 'Split Type':

Write-up: Chest pain, fever 100;


Changed on 10/14/2018

VAERS ID: 36317 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Illinois
Vaccinated:1991-10-18
Onset:1991-10-22
Submitted:1991-11-07
Entered:1991-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / UNK - / IM A

Administered by: Private      Purchased by: Public
Symptoms: Chest pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Theodur, lasix, vasotec, vistaril; amitriptyline
Current Illness:
Preexisting Conditions: hypertension, COPD, anxiety
Allergies:
Diagnostic Lab Data: segs-86, bands 5, lymph 4, mono 3, EOS 2;
CDC 'Split Type':

Write-up: Chest pain, fever 100;

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