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This is VAERS ID 37791

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 37791
VAERS Form:
Age:33.9
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH - / 0 - / -

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, HEADACHE, PLEOCYTOSIS

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type':

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;


Changed on 12/8/2009

VAERS ID: 37791 Before After
VAERS Form:
Age:33.9
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-10 1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC - / 0 - / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Headache, Pleocytosis, Pyrexia, FEVER, HEADACHE, PLEOCYTOSIS

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type': (blank) 891310001J

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;


Changed on 8/31/2010

VAERS ID: 37791 Before After
VAERS Form:
Age:33.9
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / 0 - / -

Administered by: Public      Purchased by: Public
Symptoms: Headache, Pleocytosis, Pyrexia

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type': 891310001J

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;


Changed on 7/7/2013

VAERS ID: 37791 Before After
VAERS Form:
Age:33.9
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 0 - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 0 - / -

Administered by: Public      Purchased by: Public
Symptoms: Headache, Pleocytosis, Pyrexia

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type': 891310001J

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;


Changed on 12/14/2016

VAERS ID: 37791 Before After
VAERS Form:
Age:33.9
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 0 - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 0 - / -

Administered by: Public      Purchased by: Public
Symptoms: Headache, Pleocytosis, Pyrexia

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type': 891310001J

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;


Changed on 2/14/2017

VAERS ID: 37791 Before After
VAERS Form:
Age:33.9 33.0
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 0 - / -

Administered by: Public      Purchased by: Public
Symptoms: Headache, Pleocytosis, Pyrexia

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type': 891310001J

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;


Changed on 5/14/2017

VAERS ID: 37791 Before After
VAERS Form:
Age:33.0
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 0 - / -

Administered by: Public      Purchased by: Public
Symptoms: Headache, Pleocytosis, Pyrexia

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type': 891310001J

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;


Changed on 9/14/2017

VAERS ID: 37791 Before After
VAERS Form:(blank) 1
Age:33.0
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 0 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Headache, Pleocytosis, Pyrexia

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type': 891310001J

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;


Changed on 2/14/2018

VAERS ID: 37791 Before After
VAERS Form:1
Age:33.0
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Headache, Pleocytosis, Pyrexia

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type': 891310001J

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;


Changed on 6/14/2018

VAERS ID: 37791 Before After
VAERS Form:1
Age:33.0
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Headache, Pleocytosis, Pyrexia

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type': 891310001J

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;


Changed on 8/14/2018

VAERS ID: 37791 Before After
VAERS Form:1
Age:33.0
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Headache, Pleocytosis, Pyrexia

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type': 891310001J

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;


Changed on 9/14/2018

VAERS ID: 37791 Before After
VAERS Form:1
Age:33.0
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Headache, Pleocytosis, Pyrexia

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type': 891310001J

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;


Changed on 10/14/2018

VAERS ID: 37791 Before After
VAERS Form:1
Age:33.0
Sex:Female
Location:New York
Vaccinated:1991-10-18
Onset:0000-00-00
Submitted:1991-10-28
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Headache, Pleocytosis, Pyrexia

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: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: Sxs of URI;
Preexisting Conditions: Pt has a hx of mild asthma;
Allergies:
Diagnostic Lab Data: CSF-WBC-28total, PMN 52%, Monos 48%, RBC-1, Protein-27, Glucose-75; Meningococcus-?; strep pyogens-neg; group B strep-neg; E. Coli-neg; CSF culture-neg; VDRL-neg;
CDC 'Split Type': 891310001J

Write-up: 4 days p/receiving flu vax pt was admitted to hosp 22OCT91 w/t100, severe h/a, and an abnormal LP which showed pleocytosis; cerebrospinal fluid culture was neg; pt recovered uneventfully, w/no neurologic sequelae;

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