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This is VAERS ID 36656

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36656
VAERS Form:
Age:70.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-11-07
Onset:1991-11-07
Submitted:1991-11-21
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: HYPOTONIA, DIZZINESS, NAUSEA, BRADYCARDIA, DYSPNEA

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol, Norpace, synthroid
Current Illness:
Preexisting Conditions: arrythmias (PAT, RBBB) xmany yrs; goiter; depression; peptic ulcer disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 7NOV91 & approx 1030 7NOV, pt felt lightheaded, nauseous, SOB; pt collapsed w/o LOC, & ambulance was called; pt was bradycardic (pulse 20''s) atropine & epi given en route to ER; In ER had resp distress;


Changed on 12/8/2009

VAERS ID: 36656 Before After
VAERS Form:
Age:70.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-11-07
Onset:1991-11-07
Submitted:1991-11-21
Entered:1991-12-03 1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Bradycardia, Dizziness, Dyspnoea, Hypotonia, Nausea, HYPOTONIA, DIZZINESS, NAUSEA, BRADYCARDIA, DYSPNEA

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol, Norpace, synthroid
Current Illness:
Preexisting Conditions: arrythmias (PAT, RBBB) xmany yrs; goiter; depression; peptic ulcer disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 7NOV91 & approx 1030 7NOV, pt felt lightheaded, nauseous, SOB; pt collapsed w/o LOC, & ambulance was called; pt was bradycardic (pulse 20''s) atropine & epi given en route to ER; In ER had resp distress;


Changed on 7/7/2013

VAERS ID: 36656 Before After
VAERS Form:
Age:70.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-11-07
Onset:1991-11-07
Submitted:1991-11-21
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Bradycardia, Dizziness, Dyspnoea, Hypotonia, Nausea

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol, Norpace, synthroid
Current Illness:
Preexisting Conditions: arrythmias (PAT, RBBB) xmany yrs; goiter; depression; peptic ulcer disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 7NOV91 & approx 1030 7NOV, pt felt lightheaded, nauseous, SOB; pt collapsed w/o LOC, & ambulance was called; pt was bradycardic (pulse 20''s) atropine & epi given en route to ER; In ER had resp distress;


Changed on 12/14/2016

VAERS ID: 36656 Before After
VAERS Form:
Age:70.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-11-07
Onset:1991-11-07
Submitted:1991-11-21
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Bradycardia, Dizziness, Dyspnoea, Hypotonia, Nausea

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol, Norpace, synthroid
Current Illness:
Preexisting Conditions: arrythmias (PAT, RBBB) xmany yrs; goiter; depression; peptic ulcer disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 7NOV91 & approx 1030 7NOV, pt felt lightheaded, nauseous, SOB; pt collapsed w/o LOC, & ambulance was called; pt was bradycardic (pulse 20''s) atropine & epi given en route to ER; In ER had resp distress;


Changed on 5/14/2017

VAERS ID: 36656 Before After
VAERS Form:
Age:70.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-11-07
Onset:1991-11-07
Submitted:1991-11-21
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Bradycardia, Dizziness, Dyspnoea, Hypotonia, Nausea

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol, Norpace, synthroid
Current Illness:
Preexisting Conditions: arrythmias (PAT, RBBB) xmany yrs; goiter; depression; peptic ulcer disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 7NOV91 & approx 1030 7NOV, pt felt lightheaded, nauseous, SOB; pt collapsed w/o LOC, & ambulance was called; pt was bradycardic (pulse 20''s) atropine & epi given en route to ER; In ER had resp distress;


Changed on 9/14/2017

VAERS ID: 36656 Before After
VAERS Form:(blank) 1
Age:70.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-11-07
Onset:1991-11-07
Submitted:1991-11-21
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Bradycardia, Dizziness, Dyspnoea, Hypotonia, Nausea

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol, Norpace, synthroid
Current Illness:
Preexisting Conditions: arrythmias (PAT, RBBB) xmany yrs; goiter; depression; peptic ulcer disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 7NOV91 & approx 1030 7NOV, pt felt lightheaded, nauseous, SOB; pt collapsed w/o LOC, & ambulance was called; pt was bradycardic (pulse 20''s) atropine & epi given en route to ER; In ER had resp distress;


Changed on 2/14/2018

VAERS ID: 36656 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-11-07
Onset:1991-11-07
Submitted:1991-11-21
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Bradycardia, Dizziness, Dyspnoea, Hypotonia, Nausea

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol, Norpace, synthroid
Current Illness:
Preexisting Conditions: arrythmias (PAT, RBBB) xmany yrs; goiter; depression; peptic ulcer disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 7NOV91 & approx 1030 7NOV, pt felt lightheaded, nauseous, SOB; pt collapsed w/o LOC, & ambulance was called; pt was bradycardic (pulse 20''s) atropine & epi given en route to ER; In ER had resp distress;


Changed on 6/14/2018

VAERS ID: 36656 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-11-07
Onset:1991-11-07
Submitted:1991-11-21
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Bradycardia, Dizziness, Dyspnoea, Hypotonia, Nausea

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol, Norpace, synthroid
Current Illness:
Preexisting Conditions: arrythmias (PAT, RBBB) xmany yrs; goiter; depression; peptic ulcer disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 7NOV91 & approx 1030 7NOV, pt felt lightheaded, nauseous, SOB; pt collapsed w/o LOC, & ambulance was called; pt was bradycardic (pulse 20''s) atropine & epi given en route to ER; In ER had resp distress;


Changed on 8/14/2018

VAERS ID: 36656 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-11-07
Onset:1991-11-07
Submitted:1991-11-21
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Bradycardia, Dizziness, Dyspnoea, Hypotonia, Nausea

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol, Norpace, synthroid
Current Illness:
Preexisting Conditions: arrythmias (PAT, RBBB) xmany yrs; goiter; depression; peptic ulcer disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 7NOV91 & approx 1030 7NOV, pt felt lightheaded, nauseous, SOB; pt collapsed w/o LOC, & ambulance was called; pt was bradycardic (pulse 20''s) atropine & epi given en route to ER; In ER had resp distress;


Changed on 9/14/2018

VAERS ID: 36656 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-11-07
Onset:1991-11-07
Submitted:1991-11-21
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Bradycardia, Dizziness, Dyspnoea, Hypotonia, Nausea

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol, Norpace, synthroid
Current Illness:
Preexisting Conditions: arrythmias (PAT, RBBB) xmany yrs; goiter; depression; peptic ulcer disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 7NOV91 & approx 1030 7NOV, pt felt lightheaded, nauseous, SOB; pt collapsed w/o LOC, & ambulance was called; pt was bradycardic (pulse 20''s) atropine & epi given en route to ER; In ER had resp distress;


Changed on 10/14/2018

VAERS ID: 36656 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:Wisconsin
Vaccinated:1991-11-07
Onset:1991-11-07
Submitted:1991-11-21
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Bradycardia, Dizziness, Dyspnoea, Hypotonia, Nausea

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol, Norpace, synthroid
Current Illness:
Preexisting Conditions: arrythmias (PAT, RBBB) xmany yrs; goiter; depression; peptic ulcer disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 7NOV91 & approx 1030 7NOV, pt felt lightheaded, nauseous, SOB; pt collapsed w/o LOC, & ambulance was called; pt was bradycardic (pulse 20''s) atropine & epi given en route to ER; In ER had resp distress;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=36656&WAYBACKHISTORY=ON


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