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This is VAERS ID 57464

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 57464
VAERS Form:
Age:39.2
Sex:Female
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1993-1994 EVANS MED & LEDERLE / LEDERLE 4938121 / - - / IM
PPV: PNEUMOVAX 23 / MSD 358957 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: FEVER, RASH, PRURITUS, PAIN, EDEMA PERIPH

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: NA
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax in rt arm & exp inc pain in arm as day went on; 29OCT93 very sl rash & t100.8; 30OCT93 inc rash & arm swelling t99.8; 31OCT93 temp normal total body rash hot & itchy;


Changed on 12/8/2009

VAERS ID: 57464 Before After
VAERS Form:
Age:39.2
Sex:Female
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-24 1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1993-1994 EVANS MED & LEDERLE INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LEDERLE LABORATORIES 4938121 / - - / IM
PPV: PNEUMOVAX 23 PNEUMO (PNEUMOVAX) / MSD MERCK & CO. INC. 358957 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Pruritus, Pyrexia, Rash, Vasodilatation, FEVER, RASH, PRURITUS, PAIN, EDEMA PERIPH

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: NA
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax in rt arm & exp inc pain in arm as day went on; 29OCT93 very sl rash & t100.8; 30OCT93 inc rash & arm swelling t99.8; 31OCT93 temp normal total body rash hot & itchy;


Changed on 7/7/2013

VAERS ID: 57464 Before After
VAERS Form:
Age:39.2
Sex:Female
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 4938121 / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 4938121 / - - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 358957 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Pruritus, Pyrexia, Rash, Vasodilatation

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: NA
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax in rt arm & exp inc pain in arm as day went on; 29OCT93 very sl rash & t100.8; 30OCT93 inc rash & arm swelling t99.8; 31OCT93 temp normal total body rash hot & itchy;


Changed on 2/14/2017

VAERS ID: 57464 Before After
VAERS Form:
Age:39.2 39.0
Sex:Female
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 4938121 / - - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 358957 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Pruritus, Pyrexia, Rash, Vasodilatation

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: NA
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax in rt arm & exp inc pain in arm as day went on; 29OCT93 very sl rash & t100.8; 30OCT93 inc rash & arm swelling t99.8; 31OCT93 temp normal total body rash hot & itchy;


Changed on 5/14/2017

VAERS ID: 57464 Before After
VAERS Form:
Age:39.0
Sex:Female
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 4938121 / - - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 358957 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Pruritus, Pyrexia, Rash, Vasodilatation

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: NA
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax in rt arm & exp inc pain in arm as day went on; 29OCT93 very sl rash & t100.8; 30OCT93 inc rash & arm swelling t99.8; 31OCT93 temp normal total body rash hot & itchy;


Changed on 9/14/2017

VAERS ID: 57464 Before After
VAERS Form:(blank) 1
Age:39.0
Sex:Female
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 4938121 / - UNK - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 358957 / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Pruritus, Pyrexia, Rash, Vasodilatation

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: NA
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax in rt arm & exp inc pain in arm as day went on; 29OCT93 very sl rash & t100.8; 30OCT93 inc rash & arm swelling t99.8; 31OCT93 temp normal total body rash hot & itchy;


Changed on 2/14/2018

VAERS ID: 57464 Before After
VAERS Form:1
Age:39.0
Sex:Female
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 4938121 / UNK - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 358957 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Pruritus, Pyrexia, Rash, Vasodilatation

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: NA
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax in rt arm & exp inc pain in arm as day went on; 29OCT93 very sl rash & t100.8; 30OCT93 inc rash & arm swelling t99.8; 31OCT93 temp normal total body rash hot & itchy;


Changed on 6/14/2018

VAERS ID: 57464 Before After
VAERS Form:1
Age:39.0
Sex:Female
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 4938121 / UNK - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 358957 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Pruritus, Pyrexia, Rash, Vasodilatation

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: NA
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax in rt arm & exp inc pain in arm as day went on; 29OCT93 very sl rash & t100.8; 30OCT93 inc rash & arm swelling t99.8; 31OCT93 temp normal total body rash hot & itchy;


Changed on 8/14/2018

VAERS ID: 57464 Before After
VAERS Form:1
Age:39.0
Sex:Female
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 4938121 / UNK - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 358957 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Pruritus, Pyrexia, Rash, Vasodilatation

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: NA
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax in rt arm & exp inc pain in arm as day went on; 29OCT93 very sl rash & t100.8; 30OCT93 inc rash & arm swelling t99.8; 31OCT93 temp normal total body rash hot & itchy;


Changed on 9/14/2018

VAERS ID: 57464 Before After
VAERS Form:1
Age:39.0
Sex:Female
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 4938121 / UNK - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 358957 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Pruritus, Pyrexia, Rash, Vasodilatation

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: NA
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax in rt arm & exp inc pain in arm as day went on; 29OCT93 very sl rash & t100.8; 30OCT93 inc rash & arm swelling t99.8; 31OCT93 temp normal total body rash hot & itchy;


Changed on 10/14/2018

VAERS ID: 57464 Before After
VAERS Form:1
Age:39.0
Sex:Female
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 4938121 / UNK - / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 358957 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Pruritus, Pyrexia, Rash, Vasodilatation

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: NA
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax in rt arm & exp inc pain in arm as day went on; 29OCT93 very sl rash & t100.8; 30OCT93 inc rash & arm swelling t99.8; 31OCT93 temp normal total body rash hot & itchy;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=57464&WAYBACKHISTORY=ON


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