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This is VAERS ID 36629

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36629
VAERS Form:
Age:71.3
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918202 / - A / IM

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, ASTHENIA, MYASTHENIA, HYPERTENS, CEREBROVASC ACCID

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

Changed on 12/8/2009

VAERS ID: 36629 Before After
VAERS Form:
Age:71.3
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-12-03 1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918202 / - A / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Asthenia, Cerebrovascular accident, Hypertension, Myasthenic syndrome, Pneumonia, Pyrexia, FEVER, ASTHENIA, MYASTHENIA, HYPERTENS, CEREBROVASC ACCID

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

Changed on 8/31/2010

VAERS ID: 36629 Before After
VAERS Form:
Age:71.3
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918202 / - A / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Cerebrovascular accident, Hypertension, Myasthenic syndrome, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

Changed on 7/7/2013

VAERS ID: 36629 Before After
VAERS Form:
Age:71.3
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / - A / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / - A / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Cerebrovascular accident, Hypertension, Myasthenic syndrome, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

Changed on 12/14/2016

VAERS ID: 36629 Before After
VAERS Form:
Age:71.3
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / - A / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / - A / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Cerebrovascular accident, Hypertension, Myasthenic syndrome, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

Changed on 2/14/2017

VAERS ID: 36629 Before After
VAERS Form:
Age:71.3 71.0
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / - A / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Cerebrovascular accident, Hypertension, Myasthenic syndrome, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

Changed on 5/14/2017

VAERS ID: 36629 Before After
VAERS Form:
Age:71.0
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / - A - / IM IM A

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Cerebrovascular accident, Hypertension, Myasthenic syndrome, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

Changed on 9/14/2017

VAERS ID: 36629 Before After
VAERS Form:(blank) 1
Age:71.0
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / - UNK - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Cerebrovascular accident, Hypertension, Myasthenic syndrome, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

Changed on 2/14/2018

VAERS ID: 36629 Before After
VAERS Form:1
Age:71.0
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / UNK - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Cerebrovascular accident, Hypertension, Myasthenic syndrome, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

Changed on 6/14/2018

VAERS ID: 36629 Before After
VAERS Form:1
Age:71.0
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / UNK - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Cerebrovascular accident, Hypertension, Myasthenic syndrome, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

Changed on 8/14/2018

VAERS ID: 36629 Before After
VAERS Form:1
Age:71.0
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / UNK - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Cerebrovascular accident, Hypertension, Myasthenic syndrome, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

Changed on 9/14/2018

VAERS ID: 36629 Before After
VAERS Form:1
Age:71.0
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / UNK - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Cerebrovascular accident, Hypertension, Myasthenic syndrome, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

Changed on 10/14/2018

VAERS ID: 36629 Before After
VAERS Form:1
Age:71.0
Sex:Female
Location:Michigan
Vaccinated:1991-09-27
Onset:1991-09-28
Submitted:1991-10-01
Entered:1991-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / UNK - / IM A

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Cerebrovascular accident, Hypertension, Myasthenic syndrome, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: C/o lt sided weakness became weak, lost strength; BP 190/100, t103.5 treated & released @ ER 28SEP; hospitalized 4 days later w/pneumonia ? sl stroke;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=36629&WAYBACKHISTORY=ON


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