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This is VAERS ID 36485

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36485
VAERS Form:
Age:64.2
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918169 / 1 - / -
PPV: PNU-IMUNE(R)23 / LEDERLE 302959 / 0 - / -

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, ANOREXIA, PNEUMONIA, COUGH INC, SALIVA INC

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:     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': Severe bronchitis, CHF

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


Changed on 12/8/2009

VAERS ID: 36485 Before After
VAERS Form:
Age:64.2
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-25 1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918169 / 1 - / -
PPV: PNU-IMUNE(R)23 PNEUMO (PNU-IMUNE) / LEDERLE LEDERLE LABORATORIES 302959 / 0 - / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion, FEVER, ANOREXIA, PNEUMONIA, COUGH INC, SALIVA INC

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:     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': Severe bronchitis, CHF CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


Changed on 8/31/2010

VAERS ID: 36485 Before After
VAERS Form:
Age:64.2
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918169 / 1 - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 302959 / 0 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion

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:     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


Changed on 7/7/2013

VAERS ID: 36485 Before After
VAERS Form:
Age:64.2
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 302959 / 0 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion

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:     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


Changed on 12/14/2016

VAERS ID: 36485 Before After
VAERS Form:
Age:64.2
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 302959 / 0 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion

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:     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


Changed on 2/14/2017

VAERS ID: 36485 Before After
VAERS Form:
Age:64.2 64.0
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 302959 / 0 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion

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:     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


Changed on 5/14/2017

VAERS ID: 36485 Before After
VAERS Form:
Age:64.0
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 302959 / 0 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion

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:     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


Changed on 9/14/2017

VAERS ID: 36485 Before After
VAERS Form:(blank) 1
Age:64.0
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 1 2 - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 302959 / 0 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion

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:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


Changed on 2/14/2018

VAERS ID: 36485 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 2 - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 302959 / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion

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:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


Changed on 6/14/2018

VAERS ID: 36485 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 2 - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 302959 / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion

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:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


Changed on 8/14/2018

VAERS ID: 36485 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 2 - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 302959 / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion

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:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


Changed on 9/14/2018

VAERS ID: 36485 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 2 - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 302959 / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion

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:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;


Changed on 10/14/2018

VAERS ID: 36485 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:California
Vaccinated:1991-10-24
Onset:1991-10-28
Submitted:1991-11-05
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918169 / 2 - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 302959 / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Cough, Pneumonia, Pyrexia, Salivary hypersecretion

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:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: Bronchitis chronic, heart problem
Preexisting Conditions: Severe bronchitis, CHF
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA91132

Write-up: Onset 28OCT91, fever 103, cough, copious sputum, anorexia, pneumonia;

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