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This is VAERS ID 36558

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36558
VAERS Form:
Age:63.9
Sex:Female
Location:West Virginia
Vaccinated:1991-10-29
Onset:1991-10-29
Submitted:1991-11-14
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 / PARKE-DAVIS 01401P / 0 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: HYPOTENS, ASTHENIA, AMBLYOPIA, PALPITAT

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zantac & Pepzid tabs
Current Illness: alcoholic liver cirrhosis
Preexisting Conditions: peptic ulcer disease
Allergies:
Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal
CDC 'Split Type':

Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization;


Changed on 12/8/2009

VAERS ID: 36558 Before After
VAERS Form:
Age:63.9
Sex:Female
Location:West Virginia
Vaccinated:1991-10-29
Onset:1991-10-29
Submitted:1991-11-14
Entered:1991-11-26 1991-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 INFLUENZA (SEASONAL) (FLUOGEN 91-92) / PARKE-DAVIS 01401P / 0 LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Amblyopia, Asthenia, Hypotension, Palpitations, HYPOTENS, ASTHENIA, AMBLYOPIA, PALPITAT

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zantac & Pepzid tabs
Current Illness: alcoholic liver cirrhosis
Preexisting Conditions: peptic ulcer disease
Allergies:
Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal
CDC 'Split Type': (blank) WV9149

Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization;


Changed on 8/31/2010

VAERS ID: 36558 Before After
VAERS Form:
Age:63.9
Sex:Female
Location:West Virginia
Vaccinated:1991-10-29
Onset:1991-10-29
Submitted:1991-11-14
Entered:1991-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 91-92) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01401P / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Amblyopia, Asthenia, Hypotension, Palpitations

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zantac & Pepzid tabs
Current Illness: alcoholic liver cirrhosis
Preexisting Conditions: peptic ulcer disease
Allergies:
Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal
CDC 'Split Type': WV9149

Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization;


Changed on 7/7/2013

VAERS ID: 36558 Before After
VAERS Form:
Age:63.9
Sex:Female
Location:West Virginia
Vaccinated:1991-10-29
Onset:1991-10-29
Submitted:1991-11-14
Entered:1991-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01401P / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01401P / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Amblyopia, Asthenia, Hypotension, Palpitations

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zantac & Pepzid tabs
Current Illness: alcoholic liver cirrhosis
Preexisting Conditions: peptic ulcer disease
Allergies:
Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal
CDC 'Split Type': WV9149

Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization;


Changed on 2/14/2017

VAERS ID: 36558 Before After
VAERS Form:
Age:63.9 63.0
Sex:Female
Location:West Virginia
Vaccinated:1991-10-29
Onset:1991-10-29
Submitted:1991-11-14
Entered:1991-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01401P / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Amblyopia, Asthenia, Hypotension, Palpitations

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zantac & Pepzid tabs
Current Illness: alcoholic liver cirrhosis
Preexisting Conditions: peptic ulcer disease
Allergies:
Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal
CDC 'Split Type': WV9149

Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization;


Changed on 5/14/2017

VAERS ID: 36558 Before After
VAERS Form:
Age:63.0
Sex:Female
Location:West Virginia
Vaccinated:1991-10-29
Onset:1991-10-29
Submitted:1991-11-14
Entered:1991-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01401P / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Amblyopia, Asthenia, Hypotension, Palpitations

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: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zantac & Pepzid tabs
Current Illness: alcoholic liver cirrhosis
Preexisting Conditions: peptic ulcer disease
Allergies:
Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal
CDC 'Split Type': WV9149

Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization;


Changed on 9/14/2017

VAERS ID: 36558 Before After
VAERS Form:(blank) 1
Age:63.0
Sex:Female
Location:West Virginia
Vaccinated:1991-10-29
Onset:1991-10-29
Submitted:1991-11-14
Entered:1991-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01401P / 0 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Amblyopia, Asthenia, Hypotension, Palpitations

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: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zantac & Pepzid tabs
Current Illness: alcoholic liver cirrhosis
Preexisting Conditions: peptic ulcer disease
Allergies:
Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal
CDC 'Split Type': WV9149

Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization;


Changed on 2/14/2018

VAERS ID: 36558 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:West Virginia
Vaccinated:1991-10-29
Onset:1991-10-29
Submitted:1991-11-14
Entered:1991-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01401P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Amblyopia, Asthenia, Hypotension, Palpitations

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: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zantac & Pepzid tabs
Current Illness: alcoholic liver cirrhosis
Preexisting Conditions: peptic ulcer disease
Allergies:
Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal
CDC 'Split Type': WV9149

Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization;


Changed on 6/14/2018

VAERS ID: 36558 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:West Virginia
Vaccinated:1991-10-29
Onset:1991-10-29
Submitted:1991-11-14
Entered:1991-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01401P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Amblyopia, Asthenia, Hypotension, Palpitations

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: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zantac & Pepzid tabs
Current Illness: alcoholic liver cirrhosis
Preexisting Conditions: peptic ulcer disease
Allergies:
Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal
CDC 'Split Type': WV9149

Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization;


Changed on 8/14/2018

VAERS ID: 36558 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:West Virginia
Vaccinated:1991-10-29
Onset:1991-10-29
Submitted:1991-11-14
Entered:1991-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01401P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Amblyopia, Asthenia, Hypotension, Palpitations

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: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zantac & Pepzid tabs
Current Illness: alcoholic liver cirrhosis
Preexisting Conditions: peptic ulcer disease
Allergies:
Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal
CDC 'Split Type': WV9149

Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization;


Changed on 9/14/2018

VAERS ID: 36558 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:West Virginia
Vaccinated:1991-10-29
Onset:1991-10-29
Submitted:1991-11-14
Entered:1991-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01401P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Amblyopia, Asthenia, Hypotension, Palpitations

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: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zantac & Pepzid tabs
Current Illness: alcoholic liver cirrhosis
Preexisting Conditions: peptic ulcer disease
Allergies:
Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal
CDC 'Split Type': WV9149

Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization;


Changed on 10/14/2018

VAERS ID: 36558 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:West Virginia
Vaccinated:1991-10-29
Onset:1991-10-29
Submitted:1991-11-14
Entered:1991-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01401P / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Amblyopia, Asthenia, Hypotension, Palpitations

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: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Zantac & Pepzid tabs
Current Illness: alcoholic liver cirrhosis
Preexisting Conditions: peptic ulcer disease
Allergies:
Diagnostic Lab Data: EKG''s, cardiac enzymes & extensive stress test-all normal
CDC 'Split Type': WV9149

Write-up: Approx 3 hrs p/vax recvd pt exp palpitaitons, weakness & blurred vision; Also was hypotensive 50-60/40 requiring IV fluids & hospitalization;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=36558&WAYBACKHISTORY=ON


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