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This is VAERS ID 42124

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 42124
VAERS Form:
Age:55.0
Sex:Female
Location:Washington
Vaccinated:0000-00-00
Onset:1991-11-01
Submitted:0000-00-00
Entered:1992-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: RASH, EDEMA FACE, CREATINE PK INC, DERMATOMYOSITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness:
Preexisting Conditions: no hx of allergy to eggs;
Allergies:
Diagnostic Lab Data: elevated CPK; EMG; musclebiopsy-nl biopsy;
CDC 'Split Type':

Write-up: Devel dermatopolymyositis 5 days p/flu vax; devel swollen face & rash;


Changed on 12/8/2009

VAERS ID: 42124 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:Washington
Vaccinated:0000-00-00
Onset:1991-11-01
Submitted:0000-00-00
Entered:1992-05-28 1992-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood creatine phosphokinase increased, Dermatomyositis, Face oedema, Rash, RASH, EDEMA FACE, CREATINE PK INC, DERMATOMYOSITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness:
Preexisting Conditions: no hx of allergy to eggs;
Allergies:
Diagnostic Lab Data: elevated CPK; EMG; musclebiopsy-nl biopsy;
CDC 'Split Type':

Write-up: Devel dermatopolymyositis 5 days p/flu vax; devel swollen face & rash;


Changed on 7/7/2013

VAERS ID: 42124 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:Washington
Vaccinated:0000-00-00
Onset:1991-11-01
Submitted:0000-00-00
Entered:1992-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood creatine phosphokinase increased, Dermatomyositis, Face oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness:
Preexisting Conditions: no hx of allergy to eggs;
Allergies:
Diagnostic Lab Data: elevated CPK; EMG; musclebiopsy-nl biopsy;
CDC 'Split Type':

Write-up: Devel dermatopolymyositis 5 days p/flu vax; devel swollen face & rash;


Changed on 12/14/2016

VAERS ID: 42124 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:Washington
Vaccinated:0000-00-00
Onset:1991-11-01
Submitted:0000-00-00
Entered:1992-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood creatine phosphokinase increased, Dermatomyositis, Face oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness:
Preexisting Conditions: no hx of allergy to eggs;
Allergies:
Diagnostic Lab Data: elevated CPK; EMG; musclebiopsy-nl biopsy;
CDC 'Split Type':

Write-up: Devel dermatopolymyositis 5 days p/flu vax; devel swollen face & rash;


Changed on 5/14/2017

VAERS ID: 42124 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:Washington
Vaccinated:0000-00-00
Onset:1991-11-01
Submitted:0000-00-00
Entered:1992-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood creatine phosphokinase increased, Dermatomyositis, Face oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness:
Preexisting Conditions: no hx of allergy to eggs;
Allergies:
Diagnostic Lab Data: elevated CPK; EMG; musclebiopsy-nl biopsy;
CDC 'Split Type':

Write-up: Devel dermatopolymyositis 5 days p/flu vax; devel swollen face & rash;


Changed on 9/14/2017

VAERS ID: 42124 Before After
VAERS Form:(blank) 1
Age:55.0
Sex:Female
Location:Washington
Vaccinated:0000-00-00
Onset:1991-11-01
Submitted:0000-00-00
Entered:1992-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood creatine phosphokinase increased, Dermatomyositis, Face oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness:
Preexisting Conditions: no hx of allergy to eggs;
Allergies:
Diagnostic Lab Data: elevated CPK; EMG; musclebiopsy-nl biopsy;
CDC 'Split Type':

Write-up: Devel dermatopolymyositis 5 days p/flu vax; devel swollen face & rash;


Changed on 2/14/2018

VAERS ID: 42124 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Washington
Vaccinated:0000-00-00
Onset:1991-11-01
Submitted:0000-00-00
Entered:1992-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood creatine phosphokinase increased, Dermatomyositis, Face oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness:
Preexisting Conditions: no hx of allergy to eggs;
Allergies:
Diagnostic Lab Data: elevated CPK; EMG; musclebiopsy-nl biopsy;
CDC 'Split Type':

Write-up: Devel dermatopolymyositis 5 days p/flu vax; devel swollen face & rash;


Changed on 6/14/2018

VAERS ID: 42124 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Washington
Vaccinated:0000-00-00
Onset:1991-11-01
Submitted:0000-00-00
Entered:1992-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood creatine phosphokinase increased, Dermatomyositis, Face oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness:
Preexisting Conditions: no hx of allergy to eggs;
Allergies:
Diagnostic Lab Data: elevated CPK; EMG; musclebiopsy-nl biopsy;
CDC 'Split Type':

Write-up: Devel dermatopolymyositis 5 days p/flu vax; devel swollen face & rash;


Changed on 8/14/2018

VAERS ID: 42124 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Washington
Vaccinated:0000-00-00
Onset:1991-11-01
Submitted:0000-00-00
Entered:1992-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood creatine phosphokinase increased, Dermatomyositis, Face oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness:
Preexisting Conditions: no hx of allergy to eggs;
Allergies:
Diagnostic Lab Data: elevated CPK; EMG; musclebiopsy-nl biopsy;
CDC 'Split Type':

Write-up: Devel dermatopolymyositis 5 days p/flu vax; devel swollen face & rash;


Changed on 9/14/2018

VAERS ID: 42124 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Washington
Vaccinated:0000-00-00
Onset:1991-11-01
Submitted:0000-00-00
Entered:1992-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood creatine phosphokinase increased, Dermatomyositis, Face oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness:
Preexisting Conditions: no hx of allergy to eggs;
Allergies:
Diagnostic Lab Data: elevated CPK; EMG; musclebiopsy-nl biopsy;
CDC 'Split Type':

Write-up: Devel dermatopolymyositis 5 days p/flu vax; devel swollen face & rash;


Changed on 10/14/2018

VAERS ID: 42124 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Washington
Vaccinated:0000-00-00
Onset:1991-11-01
Submitted:0000-00-00
Entered:1992-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood creatine phosphokinase increased, Dermatomyositis, Face oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness:
Preexisting Conditions: no hx of allergy to eggs;
Allergies:
Diagnostic Lab Data: elevated CPK; EMG; musclebiopsy-nl biopsy;
CDC 'Split Type':

Write-up: Devel dermatopolymyositis 5 days p/flu vax; devel swollen face & rash;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=42124&WAYBACKHISTORY=ON


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