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This is VAERS ID 36702

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36702
VAERS Form:
Age:91.4
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918146 / 4 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, VOMIT, ANOREXIA, ASTHENIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': Allergic to penicillin;

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;


Changed on 12/8/2009

VAERS ID: 36702 Before After
VAERS Form:
Age:91.4
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-04 1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918146 / 4 LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Anorexia, Asthenia, Pyrexia, Vomiting, FEVER, VOMIT, ANOREXIA, ASTHENIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': Allergic to penicillin; MO9191

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;


Changed on 8/31/2010

VAERS ID: 36702 Before After
VAERS Form:
Age:91.4
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918146 / 4 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO9191

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;


Changed on 7/7/2013

VAERS ID: 36702 Before After
VAERS Form:
Age:91.4
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / 4 LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / 4 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO9191

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;


Changed on 12/14/2016

VAERS ID: 36702 Before After
VAERS Form:
Age:91.4
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / 4 LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / 4 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO9191

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;


Changed on 2/14/2017

VAERS ID: 36702 Before After
VAERS Form:
Age:91.4 91.0
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / 4 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO9191

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;


Changed on 5/14/2017

VAERS ID: 36702 Before After
VAERS Form:
Age:91.0
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / 4 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO9191

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;


Changed on 9/14/2017

VAERS ID: 36702 Before After
VAERS Form:(blank) 1
Age:91.0
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / 4 5 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO9191

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;


Changed on 2/14/2018

VAERS ID: 36702 Before After
VAERS Form:1
Age:91.0
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / 5 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO9191

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;


Changed on 6/14/2018

VAERS ID: 36702 Before After
VAERS Form:1
Age:91.0
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / 5 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO9191

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;


Changed on 8/14/2018

VAERS ID: 36702 Before After
VAERS Form:1
Age:91.0
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / 5 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO9191

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;


Changed on 9/14/2018

VAERS ID: 36702 Before After
VAERS Form:1
Age:91.0
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / 5 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO9191

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;


Changed on 10/14/2018

VAERS ID: 36702 Before After
VAERS Form:1
Age:91.0
Sex:Male
Location:Missouri
Vaccinated:1991-11-08
Onset:1991-11-09
Submitted:1991-11-18
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / 5 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO9191

Write-up: 09NOV91 became very weak, vomiting, poor appetite; continued to get weaker; 12NOV91 fever 101 continued for 2 days; 14NOV91 hospitalized for approx 1 day for tests; no rx - Home Health Nurse 3 x week;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=36702&WAYBACKHISTORY=ON


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