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This is VAERS ID 36727

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36727
VAERS Form:
Age:71.7
Sex:Female
Location:Illinois
Vaccinated:1991-11-06
Onset:1991-11-14
Submitted:1991-11-25
Entered:1991-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1991-1992 / CONNAUGHT LABS 1F21209 / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: NAUSEA, VOMIT, CONFUS, VERTIGO

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC 'Split Type':

Write-up: vertigo, nausea, emesis, confusion, disorientation;


Changed on 12/8/2009

VAERS ID: 36727 Before After
VAERS Form:
Age:71.7
Sex:Female
Location:Illinois
Vaccinated:1991-11-06
Onset:1991-11-14
Submitted:1991-11-25
Entered:1991-12-05 1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1991-1992 INFLUENZA (SEASONAL) (FLUZONE 91-92) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1F21209 / 0 LA / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Confusional state, Nausea, Vertigo, Vomiting, NAUSEA, VOMIT, CONFUS, VERTIGO

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC 'Split Type':

Write-up: vertigo, nausea, emesis, confusion, disorientation;


Changed on 8/31/2010

VAERS ID: 36727 Before After
VAERS Form:
Age:71.7
Sex:Female
Location:Illinois
Vaccinated:1991-11-06
Onset:1991-11-14
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 91-92) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 0 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Confusional state, Nausea, Vertigo, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC 'Split Type':

Write-up: vertigo, nausea, emesis, confusion, disorientation;


Changed on 7/7/2013

VAERS ID: 36727 Before After
VAERS Form:
Age:71.7
Sex:Female
Location:Illinois
Vaccinated:1991-11-06
Onset:1991-11-14
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 0 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Confusional state, Nausea, Vertigo, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC 'Split Type':

Write-up: vertigo, nausea, emesis, confusion, disorientation;


Changed on 2/14/2017

VAERS ID: 36727 Before After
VAERS Form:
Age:71.7 71.0
Sex:Female
Location:Illinois
Vaccinated:1991-11-06
Onset:1991-11-14
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 0 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Confusional state, Nausea, Vertigo, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC 'Split Type':

Write-up: vertigo, nausea, emesis, confusion, disorientation;


Changed on 5/14/2017

VAERS ID: 36727 Before After
VAERS Form:
Age:71.0
Sex:Female
Location:Illinois
Vaccinated:1991-11-06
Onset:1991-11-14
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 0 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Confusional state, Nausea, Vertigo, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC 'Split Type':

Write-up: vertigo, nausea, emesis, confusion, disorientation;


Changed on 9/14/2017

VAERS ID: 36727 Before After
VAERS Form:(blank) 1
Age:71.0
Sex:Female
Location:Illinois
Vaccinated:1991-11-06
Onset:1991-11-14
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 0 1 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Confusional state, Nausea, Vertigo, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC 'Split Type':

Write-up: vertigo, nausea, emesis, confusion, disorientation;


Changed on 2/14/2018

VAERS ID: 36727 Before After
VAERS Form:1
Age:71.0
Sex:Female
Location:Illinois
Vaccinated:1991-11-06
Onset:1991-11-14
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Confusional state, Nausea, Vertigo, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC 'Split Type':

Write-up: vertigo, nausea, emesis, confusion, disorientation;


Changed on 6/14/2018

VAERS ID: 36727 Before After
VAERS Form:1
Age:71.0
Sex:Female
Location:Illinois
Vaccinated:1991-11-06
Onset:1991-11-14
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Confusional state, Nausea, Vertigo, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC 'Split Type':

Write-up: vertigo, nausea, emesis, confusion, disorientation;


Changed on 8/14/2018

VAERS ID: 36727 Before After
VAERS Form:1
Age:71.0
Sex:Female
Location:Illinois
Vaccinated:1991-11-06
Onset:1991-11-14
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Confusional state, Nausea, Vertigo, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC 'Split Type':

Write-up: vertigo, nausea, emesis, confusion, disorientation;


Changed on 9/14/2018

VAERS ID: 36727 Before After
VAERS Form:1
Age:71.0
Sex:Female
Location:Illinois
Vaccinated:1991-11-06
Onset:1991-11-14
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Confusional state, Nausea, Vertigo, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC 'Split Type':

Write-up: vertigo, nausea, emesis, confusion, disorientation;


Changed on 10/14/2018

VAERS ID: 36727 Before After
VAERS Form:1
Age:71.0
Sex:Female
Location:Illinois
Vaccinated:1991-11-06
Onset:1991-11-14
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Confusional state, Nausea, Vertigo, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Naprosyn, Zestaril, Premarin
Current Illness: NONE
Preexisting Conditions: PCN, Hypertensive
Allergies:
Diagnostic Lab Data: SGOT-6; Creat-0.6; Total port-5.5; CBC-normal;
CDC 'Split Type':

Write-up: vertigo, nausea, emesis, confusion, disorientation;

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