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This is VAERS ID 40387

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 40387
VAERS Form:
Age:69.7
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918202 / 0 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: BRAIN SYND ACUTE, HYPOKINESIA, DIZZINESS, VOMIT, VESTIBUL DIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


Changed on 12/8/2009

VAERS ID: 40387 Before After
VAERS Form:
Age:69.7
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-25 1992-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918202 / 0 LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting, BRAIN SYND ACUTE, HYPOKINESIA, DIZZINESS, VOMIT, VESTIBUL DIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


Changed on 8/31/2010

VAERS ID: 40387 Before After
VAERS Form:
Age:69.7
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918202 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


Changed on 7/7/2013

VAERS ID: 40387 Before After
VAERS Form:
Age:69.7
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


Changed on 12/14/2016

VAERS ID: 40387 Before After
VAERS Form:
Age:69.7
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 0 LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


Changed on 2/14/2017

VAERS ID: 40387 Before After
VAERS Form:
Age:69.7 69.0
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


Changed on 5/14/2017

VAERS ID: 40387 Before After
VAERS Form:
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


Changed on 9/14/2017

VAERS ID: 40387 Before After
VAERS Form:(blank) 1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 0 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


Changed on 2/14/2018

VAERS ID: 40387 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


Changed on 6/14/2018

VAERS ID: 40387 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


Changed on 8/14/2018

VAERS ID: 40387 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


Changed on 9/14/2018

VAERS ID: 40387 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


Changed on 10/14/2018

VAERS ID: 40387 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Maryland
Vaccinated:1991-11-06
Onset:1991-11-06
Submitted:1991-11-20
Entered:1992-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=40387&WAYBACKHISTORY=ON


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