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This is VAERS ID 56991

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 56991
VAERS Form:
Age:15.1
Sex:Female
Location:Florida
Vaccinated:1993-10-18
Onset:1993-10-19
Submitted:1993-10-22
Entered:1993-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 / CONNAUGHT LABS 3F41028 / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, NAUSEA, SOMNOLENCE, HEADACHE

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? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': allergic to PCN; hx of asthma;

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;


Changed on 12/8/2009

VAERS ID: 56991 Before After
VAERS Form:
Age:15.1
Sex:Female
Location:Florida
Vaccinated:1993-10-18
Onset:1993-10-19
Submitted:1993-10-22
Entered:1993-11-10 1993-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 INFLUENZA (SEASONAL) (FLUZONE 93-94) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3F41028 / - LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Headache, Nausea, Pyrexia, Somnolence, FEVER, NAUSEA, SOMNOLENCE, HEADACHE

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? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': allergic to PCN; hx of asthma; (blank)

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;


Changed on 8/31/2010

VAERS ID: 56991 Before After
VAERS Form:
Age:15.1
Sex:Female
Location:Florida
Vaccinated:1993-10-18
Onset:1993-10-19
Submitted:1993-10-22
Entered:1993-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 93-94) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41028 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia, Somnolence

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? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;


Changed on 7/7/2013

VAERS ID: 56991 Before After
VAERS Form:
Age:15.1
Sex:Female
Location:Florida
Vaccinated:1993-10-18
Onset:1993-10-19
Submitted:1993-10-22
Entered:1993-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41028 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41028 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia, Somnolence

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? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;


Changed on 2/14/2017

VAERS ID: 56991 Before After
VAERS Form:
Age:15.1 15.0
Sex:Female
Location:Florida
Vaccinated:1993-10-18
Onset:1993-10-19
Submitted:1993-10-22
Entered:1993-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41028 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia, Somnolence

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? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;


Changed on 5/14/2017

VAERS ID: 56991 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Florida
Vaccinated:1993-10-18
Onset:1993-10-19
Submitted:1993-10-22
Entered:1993-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41028 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia, Somnolence

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? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;


Changed on 9/14/2017

VAERS ID: 56991 Before After
VAERS Form:(blank) 1
Age:15.0
Sex:Female
Location:Florida
Vaccinated:1993-10-18
Onset:1993-10-19
Submitted:1993-10-22
Entered:1993-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41028 / - UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia, Somnolence

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;


Changed on 2/14/2018

VAERS ID: 56991 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Florida
Vaccinated:1993-10-18
Onset:1993-10-19
Submitted:1993-10-22
Entered:1993-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41028 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia, Somnolence

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;


Changed on 6/14/2018

VAERS ID: 56991 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Florida
Vaccinated:1993-10-18
Onset:1993-10-19
Submitted:1993-10-22
Entered:1993-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41028 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia, Somnolence

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;


Changed on 8/14/2018

VAERS ID: 56991 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Florida
Vaccinated:1993-10-18
Onset:1993-10-19
Submitted:1993-10-22
Entered:1993-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41028 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia, Somnolence

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;


Changed on 9/14/2018

VAERS ID: 56991 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Florida
Vaccinated:1993-10-18
Onset:1993-10-19
Submitted:1993-10-22
Entered:1993-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41028 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia, Somnolence

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;


Changed on 10/14/2018

VAERS ID: 56991 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Florida
Vaccinated:1993-10-18
Onset:1993-10-19
Submitted:1993-10-22
Entered:1993-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41028 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Headache, Nausea, Pyrexia, Somnolence

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: denies
Preexisting Conditions: allergic to PCN; hx of asthma;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: flu shot given on 18OCT93 approx 415PM; around MN pt awoke w/fever fo 106; ran fever next day up to 104 & day p/of 100; h/a, nausea, lethargy;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=56991&WAYBACKHISTORY=ON


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