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This is VAERS ID 57465

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 57465
VAERS Form:
Age:43.8
Sex:Male
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: UNK. INFLUENZA VACCINE / UNCLASSIFIED 4938121 / - - / -
PPV: PNU-IMUNE(R)23 / LEDERLE 358957 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: EDEMA INJECT SITE, PAIN INJECT SITE, HYSN INJECT SITE, SKIN STRIAE

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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;


Changed on 12/8/2009

VAERS ID: 57465 Before After
VAERS Form:
Age:43.8
Sex:Male
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: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 4938121 / - - / -
PPV: PNU-IMUNE(R)23 PNEUMO (PNU-IMUNE) / LEDERLE LEDERLE LABORATORIES 358957 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin striae, EDEMA INJECT SITE, PAIN INJECT SITE, HYSN INJECT SITE, SKIN STRIAE

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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;


Changed on 7/7/2013

VAERS ID: 57465 Before After
VAERS Form:
Age:43.8
Sex:Male
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) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / - - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 358957 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin striae

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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;


Changed on 12/14/2016

VAERS ID: 57465 Before After
VAERS Form:
Age:43.8
Sex:Male
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) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / - - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 358957 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin striae

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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;


Changed on 2/14/2017

VAERS ID: 57465 Before After
VAERS Form:
Age:43.8 43.0
Sex:Male
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / - - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 358957 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin striae

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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;


Changed on 5/14/2017

VAERS ID: 57465 Before After
VAERS Form:
Age:43.0
Sex:Male
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / - - / -
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 358957 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin striae

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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;


Changed on 9/14/2017

VAERS ID: 57465 Before After
VAERS Form:(blank) 1
Age:43.0
Sex:Male
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / - UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 358957 / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin striae

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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;


Changed on 2/14/2018

VAERS ID: 57465 Before After
VAERS Form:1
Age:43.0
Sex:Male
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 358957 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin striae

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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;


Changed on 6/14/2018

VAERS ID: 57465 Before After
VAERS Form:1
Age:43.0
Sex:Male
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 358957 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin striae

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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;


Changed on 8/14/2018

VAERS ID: 57465 Before After
VAERS Form:1
Age:43.0
Sex:Male
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 358957 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin striae

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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;


Changed on 9/14/2018

VAERS ID: 57465 Before After
VAERS Form:1
Age:43.0
Sex:Male
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 358957 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin striae

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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;


Changed on 10/14/2018

VAERS ID: 57465 Before After
VAERS Form:1
Age:43.0
Sex:Male
Location:Michigan
Vaccinated:1993-10-28
Onset:1993-10-28
Submitted:1993-11-03
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 4938121 / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 358957 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Skin striae

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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pneumovax & flu vax given & immed burning pain-progressing to significant swelling x 3 nl size burning pain severe erythema pain from upper arm; adenopathy pain & streaking w/swelling to elbow-ax out chest wall; still some prob today;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=57465&WAYBACKHISTORY=ON


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