National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 413389

History of Changes from the VAERS Wayback Machine

First Appeared on 1/4/2011

VAERS ID: 413389
VAERS Form:
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR U3730AA / - LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 4/13/2011

VAERS ID: 413389 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR U3730AA / - LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Computerised tomogram abnormal, Cough, Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia, Respiratory tract congestion, Paranasal sinus hypersecretion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 5/13/2011

VAERS ID: 413389 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR U3730AA / - LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Computerised tomogram abnormal, Cough, Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia, Respiratory tract congestion, Paranasal sinus hypersecretion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 7/12/2011

VAERS ID: 413389 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / - LA / UN
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR U3730AA / - LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 7/7/2013

VAERS ID: 413389 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / - LA / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / - LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 6/14/2014

VAERS ID: 413389 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / - LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 10/14/2016

VAERS ID: 413389 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / - LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 12/14/2016

VAERS ID: 413389 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / - LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? No Yes
   Date died:0000-00-00 2016-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 9/14/2017

VAERS ID: 413389 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / - UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 2/14/2018

VAERS ID: 413389 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 6/14/2018

VAERS ID: 413389 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 8/14/2018

VAERS ID: 413389 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 9/14/2018

VAERS ID: 413389 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 10/14/2018

VAERS ID: 413389 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 12/24/2020

VAERS ID: 413389 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 12/30/2020

VAERS ID: 413389 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 5/7/2021

VAERS ID: 413389 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.


Changed on 5/14/2021

VAERS ID: 413389 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Alabama
Vaccinated:2010-10-21
Onset:2010-11-23
Submitted:2010-12-21
Entered:2010-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3730AA / UNK LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Feeling abnormal, Gait disturbance, Irritability, Nausea, Pyrexia, Vomiting, Mobility decreased, Balance disorder, Bradyphrenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2016-01-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: Swelling~Pneumo (no brand name)~UN~0.00~Patient|Injection site mass~Pneumo (no brand name)~UN~0.00~Patient
Other Medications: Prednisone; blood pressure pill; Vitamin B12
Current Illness:
Preexisting Conditions: History of increased blood pressure, and temporal arteritis (3 years). Additionally, the patient reported that 5 years earlier she had experienced "swelling and a hard knot" following vaccination with pneumonia vaccine.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 201007010

Write-up: This case was initially reported by a consumer, who is also the patient, on 15 December 2010. A 79-year-old female patient received an INFLUENZA VACCINE (manufacturer reported as "possibly Sanofi Pasteur", lot not reported) in the left arm on 22 November 2010. The patient had a history of increased blood pressure and temporal arteritis (for past 3 years); she had previously experienced swelling and a hard knot at the site of a pneumococcal vaccine, and had received numerous influenza vaccines in the past. Concomitant medications included prednisone, a blood pressure pill, and Vitamin B12 1000mg. According to the patient, approximately 6 hours post-vaccination she began experiencing fever, nausea, vomiting, and difficulty in moving. Approximately 12 hours post-vaccination, she had a fever of 103 degrees and was unable to get out of bed. She was seen by a physician the day after vaccination, at which time she complained of difficulty walking and "brain function problem", described as fuzziness, slow thinking process, and balance problems when walking. The patient noted that she had been seen by a "brain doctor". Outcome was not reported.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=413389&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166