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This is VAERS ID 36486

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36486
VAERS Form:
Age:78.7
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918170 / - - / -

Administered by: Public      Purchased by: Unknown
Symptoms: HYPOKINESIA, DIZZINESS, INFECT, MYALGIA, LUNG DIS

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, ""mild heartattack"" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': Hypertension, ""mild heartattack"" in Jun, 1991

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

Changed on 12/8/2009

VAERS ID: 36486 Before After
VAERS Form:
Age:78.7
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
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 4918170 / - - / -

Administered by: Public      Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Infection, Lung disorder, Myalgia, Vomiting, HYPOKINESIA, DIZZINESS, INFECT, MYALGIA, LUNG DIS

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, ""mild heartattack"" "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': Hypertension, ""mild heartattack"" in Jun, 1991 CA91133

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

Changed on 8/31/2010

VAERS ID: 36486 Before After
VAERS Form:
Age:78.7
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
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 4918170 / - - / -

Administered by: Public      Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Infection, Lung disorder, Myalgia, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': CA91133

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

Changed on 7/7/2013

VAERS ID: 36486 Before After
VAERS Form:
Age:78.7
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918170 / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918170 / - - / -

Administered by: Public      Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Infection, Lung disorder, Myalgia, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': CA91133

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

Changed on 12/14/2016

VAERS ID: 36486 Before After
VAERS Form:
Age:78.7
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918170 / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918170 / - - / -

Administered by: Public      Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Infection, Lung disorder, Myalgia, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': CA91133

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

Changed on 2/14/2017

VAERS ID: 36486 Before After
VAERS Form:
Age:78.7 78.0
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918170 / - - / -

Administered by: Public      Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Infection, Lung disorder, Myalgia, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': CA91133

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

Changed on 5/14/2017

VAERS ID: 36486 Before After
VAERS Form:
Age:78.0
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918170 / - - / -

Administered by: Public      Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Infection, Lung disorder, Myalgia, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': CA91133

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

Changed on 9/14/2017

VAERS ID: 36486 Before After
VAERS Form:(blank) 1
Age:78.0
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918170 / - UNK - / -

Administered by: Public      Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Infection, Lung disorder, Myalgia, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': CA91133

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

Changed on 2/14/2018

VAERS ID: 36486 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918170 / UNK - / -

Administered by: Public      Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Infection, Lung disorder, Myalgia, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': CA91133

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

Changed on 6/14/2018

VAERS ID: 36486 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918170 / UNK - / -

Administered by: Public      Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Infection, Lung disorder, Myalgia, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': CA91133

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

Changed on 8/14/2018

VAERS ID: 36486 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918170 / UNK - / -

Administered by: Public      Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Infection, Lung disorder, Myalgia, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': CA91133

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

Changed on 9/14/2018

VAERS ID: 36486 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918170 / UNK - / -

Administered by: Public      Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Infection, Lung disorder, Myalgia, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': CA91133

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

Changed on 10/14/2018

VAERS ID: 36486 Before After
VAERS Form:1
Age:78.0
Sex:Female
Location:California
Vaccinated:1991-10-10
Onset:1991-10-11
Submitted:0000-00-00
Entered:1991-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918170 / UNK - / -

Administered by: Public      Purchased by: Unknown
Symptoms: Dizziness, Hypokinesia, Infection, Lung disorder, Myalgia, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Hypertension, "mild heartattack" in Jun, 1991
Allergies:
Diagnostic Lab Data: CXR-showed Bilateral infiltrates;
CDC 'Split Type': CA91133

Write-up: At about MN, dizzy, unable to stand, vomiting; Ambulance transported pt to Hosp; treated w/IV ATB x 5 days, discharged on po ATB; no fever or cold sx; myalgia;

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