National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 36589

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36589
VAERS Form:
Age:2.5
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918129 / 0 LL / IM

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


Changed on 12/8/2009

VAERS ID: 36589 Before After
VAERS Form:
Age:2.5
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
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 4918129 / 0 LL / IM

Administered by: Public      Purchased by: Unknown Private
Symptoms: Convulsion, CONVULS

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


Changed on 8/31/2010

VAERS ID: 36589 Before After
VAERS Form:
Age:2.5
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
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 4918129 / 0 LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Convulsion

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


Changed on 7/7/2013

VAERS ID: 36589 Before After
VAERS Form:
Age:2.5
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 0 LL / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 0 LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Convulsion

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


Changed on 12/14/2016

VAERS ID: 36589 Before After
VAERS Form:
Age:2.5
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 0 LL / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 0 LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Convulsion

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


Changed on 2/14/2017

VAERS ID: 36589 Before After
VAERS Form:
Age:2.5 2.0
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 0 LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Convulsion

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


Changed on 5/14/2017

VAERS ID: 36589 Before After
VAERS Form:
Age:2.0
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 0 LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Convulsion

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


Changed on 9/14/2017

VAERS ID: 36589 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 0 1 LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Convulsion

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


Changed on 2/14/2018

VAERS ID: 36589 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 1 LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Convulsion

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


Changed on 6/14/2018

VAERS ID: 36589 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 1 LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Convulsion

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


Changed on 8/14/2018

VAERS ID: 36589 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 1 LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Convulsion

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


Changed on 9/14/2018

VAERS ID: 36589 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 1 LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Convulsion

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;


Changed on 10/14/2018

VAERS ID: 36589 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Pennsylvania
Vaccinated:1991-11-06
Onset:1991-11-15
Submitted:1991-11-18
Entered:1991-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918129 / 1 LL / IM

Administered by: Public      Purchased by: Private
Symptoms: Convulsion

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Flinstone Vit, KCL, Theolair, Dioril, Aldadone, Ventolin nebs, Potassium
Current Illness: NONE
Preexisting Conditions: developmental delay, BPD on ventilater- hx of abn EEG
Allergies:
Diagnostic Lab Data: Theophyllene-10.4, Electrolytes NA-138; K-3.9, CL-101, CO2-32, Glu-153;
CDC 'Split Type':

Write-up: Pt is ventilator dependent ex premature pt w/severe development delay & hx of abnormal EEG in past that 9 days p/vax generalized sz lasting 2 hrs w/o response to Anticonvulsants;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=36589&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166