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This is VAERS ID 38737

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 38737
VAERS Form:
Age:59.7
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918132 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, MYALGIA, MALAISE, EDEMA TONGUE, GLOSSITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 12/8/2009

VAERS ID: 38737 Before After
VAERS Form:
Age:59.7
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-15 1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918132 / - - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema, FEVER, MYALGIA, MALAISE, EDEMA TONGUE, GLOSSITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 8/31/2010

VAERS ID: 38737 Before After
VAERS Form:
Age:59.7
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918132 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 4/13/2011

VAERS ID: 38737 Before After
VAERS Form:
Age:59.7
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 5/13/2011

VAERS ID: 38737 Before After
VAERS Form:
Age:59.7
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 6/11/2011

VAERS ID: 38737 Before After
VAERS Form:
Age:59.7
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 7/7/2013

VAERS ID: 38737 Before After
VAERS Form:
Age:59.7
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 12/14/2016

VAERS ID: 38737 Before After
VAERS Form:
Age:59.7
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 2/14/2017

VAERS ID: 38737 Before After
VAERS Form:
Age:59.7 59.0
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 5/14/2017

VAERS ID: 38737 Before After
VAERS Form:
Age:59.0
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 9/14/2017

VAERS ID: 38737 Before After
VAERS Form:(blank) 1
Age:59.0
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / - UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 2/14/2018

VAERS ID: 38737 Before After
VAERS Form:1
Age:59.0
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 6/14/2018

VAERS ID: 38737 Before After
VAERS Form:1
Age:59.0
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 8/14/2018

VAERS ID: 38737 Before After
VAERS Form:1
Age:59.0
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 9/14/2018

VAERS ID: 38737 Before After
VAERS Form:1
Age:59.0
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;


Changed on 10/14/2018

VAERS ID: 38737 Before After
VAERS Form:1
Age:59.0
Sex:Female
Location:North Carolina
Vaccinated:1991-10-28
Onset:1991-10-28
Submitted:1991-12-10
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918132 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Aphthous stomatitis, Dysgeusia, Glossitis, Malaise, Myalgia, Pyrexia, Tongue disorder, Tongue oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: pt does not have an allergy to eggs
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 891354001J

Write-up: Pt reported tongue felt different p/recvd flu vax 28OCT91 that evening pt devel a fever & ill feeling; following day pts tongue became raw & swollen w/welts & blisters; approx 2 wks later exp difficulty breathing & chest tightness;

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