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This is VAERS ID 39021

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39021
VAERS Form:
Age:28.9
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918131 / 0 - / -

Administered by: Other      Purchased by: Unknown
Symptoms: INFLAM INJECT SITE, MASS INJECT SITE, HYPERTONIA, MYALGIA, MYOSITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type':

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


Changed on 12/8/2009

VAERS ID: 39021 Before After
VAERS Form:
Age:28.9
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-28 1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918131 / 0 - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis, INFLAM INJECT SITE, MASS INJECT SITE, HYPERTONIA, MYALGIA, MYOSITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type': (blank) 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


Changed on 8/31/2010

VAERS ID: 39021 Before After
VAERS Form:
Age:28.9
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918131 / 0 - / -

Administered by: Other      Purchased by: Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type': 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


Changed on 7/7/2013

VAERS ID: 39021 Before After
VAERS Form:
Age:28.9
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 - / -

Administered by: Other      Purchased by: Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type': 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


Changed on 12/14/2016

VAERS ID: 39021 Before After
VAERS Form:
Age:28.9
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 - / -

Administered by: Other      Purchased by: Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type': 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


Changed on 2/14/2017

VAERS ID: 39021 Before After
VAERS Form:
Age:28.9 28.0
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 - / -

Administered by: Other      Purchased by: Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type': 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


Changed on 5/14/2017

VAERS ID: 39021 Before After
VAERS Form:
Age:28.0
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 - / -

Administered by: Other      Purchased by: Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type': 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


Changed on 9/14/2017

VAERS ID: 39021 Before After
VAERS Form:(blank) 1
Age:28.0
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 0 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type': 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


Changed on 2/14/2018

VAERS ID: 39021 Before After
VAERS Form:1
Age:28.0
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type': 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


Changed on 6/14/2018

VAERS ID: 39021 Before After
VAERS Form:1
Age:28.0
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type': 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


Changed on 8/14/2018

VAERS ID: 39021 Before After
VAERS Form:1
Age:28.0
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type': 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


Changed on 9/14/2018

VAERS ID: 39021 Before After
VAERS Form:1
Age:28.0
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type': 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;


Changed on 10/14/2018

VAERS ID: 39021 Before After
VAERS Form:1
Age:28.0
Sex:Female
Location:New York
Vaccinated:1991-11-15
Onset:1991-11-16
Submitted:1992-01-09
Entered:1992-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918131 / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Hypertonia, Injection site inflammation, Injection site mass, Injection site pain, Myalgia, Myositis, Tendon disorder, Tenosynovitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Blood work & X-ray results are pending;
CDC 'Split Type': 892013001J

Write-up: Pt exp pain @ inject site the day p/recvd flu vax; This pain continued to worsen until pt was unable to work; A bump was noted @ the inject site; MD dx tendonitis; pts MD felt area was inflamed but not infected; pt currently receiving PT;

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