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This is VAERS ID 36579

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36579
VAERS Form:
Age:51.1
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918132 / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: RESPIRAT 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;


Changed on 12/8/2009

VAERS ID: 36579 Before After
VAERS Form:
Age:51.1
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-26 1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918132 / - LA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Respiratory disorder, RESPIRAT 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) AL91035

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;


Changed on 8/31/2010

VAERS ID: 36579 Before After
VAERS Form:
Age:51.1
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918132 / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL91035

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;


Changed on 7/7/2013

VAERS ID: 36579 Before After
VAERS Form:
Age:51.1
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - LA / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL91035

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;


Changed on 12/14/2016

VAERS ID: 36579 Before After
VAERS Form:
Age:51.1
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - LA / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL91035

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;


Changed on 2/14/2017

VAERS ID: 36579 Before After
VAERS Form:
Age:51.1 51.0
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL91035

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;


Changed on 5/14/2017

VAERS ID: 36579 Before After
VAERS Form:
Age:51.0
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL91035

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;


Changed on 9/14/2017

VAERS ID: 36579 Before After
VAERS Form:(blank) 1
Age:51.0
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL91035

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;


Changed on 2/14/2018

VAERS ID: 36579 Before After
VAERS Form:1
Age:51.0
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL91035

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;


Changed on 6/14/2018

VAERS ID: 36579 Before After
VAERS Form:1
Age:51.0
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL91035

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;


Changed on 8/14/2018

VAERS ID: 36579 Before After
VAERS Form:1
Age:51.0
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL91035

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;


Changed on 9/14/2018

VAERS ID: 36579 Before After
VAERS Form:1
Age:51.0
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL91035

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;


Changed on 10/14/2018

VAERS ID: 36579 Before After
VAERS Form:1
Age:51.0
Sex:Male
Location:Alabama
Vaccinated:1991-11-01
Onset:1991-11-08
Submitted:1991-11-14
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: stable @ time of vax
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL91035

Write-up: Respiratory sx w/minimal bronchiolar infiltrate-needed hospitalization 9NOV91 to 11NOV91;

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