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This is VAERS ID 36657

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36657
VAERS Form:
Age:14.5
Sex:Male
Location:Pennsylvania
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-22
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 / PARKE-DAVIS 04161P / 0 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: CYANOSIS, APNEA, DYSPNEA

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;


Changed on 12/8/2009

VAERS ID: 36657 Before After
VAERS Form:
Age:14.5
Sex:Male
Location:Pennsylvania
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-22
Entered:1991-12-03 1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 INFLUENZA (SEASONAL) (FLUOGEN 91-92) / PARKE-DAVIS 04161P / 0 RA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Cyanosis, Dyspnoea, CYANOSIS, APNEA, DYSPNEA

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;


Changed on 8/31/2010

VAERS ID: 36657 Before After
VAERS Form:
Age:14.5
Sex:Male
Location:Pennsylvania
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-22
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 91-92) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cyanosis, Dyspnoea

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;


Changed on 7/7/2013

VAERS ID: 36657 Before After
VAERS Form:
Age:14.5
Sex:Male
Location:Pennsylvania
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-22
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / 0 RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cyanosis, Dyspnoea

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;


Changed on 2/14/2017

VAERS ID: 36657 Before After
VAERS Form:
Age:14.5 14.0
Sex:Male
Location:Pennsylvania
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-22
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cyanosis, Dyspnoea

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;


Changed on 5/14/2017

VAERS ID: 36657 Before After
VAERS Form:
Age:14.0
Sex:Male
Location:Pennsylvania
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-22
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cyanosis, Dyspnoea

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;


Changed on 9/14/2017

VAERS ID: 36657 Before After
VAERS Form:(blank) 1
Age:14.0
Sex:Male
Location:Pennsylvania
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-22
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / 0 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cyanosis, Dyspnoea

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;


Changed on 2/14/2018

VAERS ID: 36657 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Pennsylvania
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-22
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cyanosis, Dyspnoea

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;


Changed on 6/14/2018

VAERS ID: 36657 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Pennsylvania
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-22
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cyanosis, Dyspnoea

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;


Changed on 8/14/2018

VAERS ID: 36657 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Pennsylvania
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-22
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cyanosis, Dyspnoea

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;


Changed on 9/14/2018

VAERS ID: 36657 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Pennsylvania
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-22
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cyanosis, Dyspnoea

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;


Changed on 10/14/2018

VAERS ID: 36657 Before After
VAERS Form:1
Age:14.0
Sex:Male
Location:Pennsylvania
Vaccinated:1991-11-18
Onset:1991-11-18
Submitted:1991-11-22
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cyanosis, Dyspnoea

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=36657&WAYBACKHISTORY=ON


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