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This is VAERS ID 63043

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 63043
VAERS Form:
Age:64.6
Sex:Male
Location:Mississippi
Vaccinated:1993-10-14
Onset:1993-10-21
Submitted:1994-05-17
Entered:1994-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 / CONNAUGHT LABS 3F41016 / 0 A / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: FEVER, INFECT, VASCULITIS, THROM

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax & 6 days later was real ill from then until 5MAR t100-103.5 24 hrs day; went into hosp 15NOV93; ATB for 40 days; temp cont; hosp 16FEB-26; vasculitis from virus; 4MAY blood clot; no sx of cold or illness until took flu shot


Changed on 12/8/2009

VAERS ID: 63043 Before After
VAERS Form:
Age:64.6
Sex:Male
Location:Mississippi
Vaccinated:1993-10-14
Onset:1993-10-21
Submitted:1994-05-17
Entered:1994-05-26 1994-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 INFLUENZA (SEASONAL) (FLUZONE 93-94) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3F41016 / 0 A / -

Administered by: Unknown      Purchased by: Unknown Public
Symptoms: Infection, Pyrexia, Thrombosis, Vasculitis, FEVER, INFECT, VASCULITIS, THROM

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax & 6 days later was real ill from then until 5MAR t100-103.5 24 hrs day; went into hosp 15NOV93; ATB for 40 days; temp cont; hosp 16FEB-26; vasculitis from virus; 4MAY blood clot; no sx of cold or illness until took flu shot


Changed on 8/31/2010

VAERS ID: 63043 Before After
VAERS Form:
Age:64.6
Sex:Male
Location:Mississippi
Vaccinated:1993-10-14
Onset:1993-10-21
Submitted:1994-05-17
Entered:1994-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 93-94) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41016 / 0 A / -

Administered by: Unknown      Purchased by: Public
Symptoms: Infection, Pyrexia, Thrombosis, Vasculitis

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax & 6 days later was real ill from then until 5MAR t100-103.5 24 hrs day; went into hosp 15NOV93; ATB for 40 days; temp cont; hosp 16FEB-26; vasculitis from virus; 4MAY blood clot; no sx of cold or illness until took flu shot


Changed on 7/7/2013

VAERS ID: 63043 Before After
VAERS Form:
Age:64.6
Sex:Male
Location:Mississippi
Vaccinated:1993-10-14
Onset:1993-10-21
Submitted:1994-05-17
Entered:1994-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41016 / 0 A / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41016 / 0 A / -

Administered by: Unknown      Purchased by: Public
Symptoms: Infection, Pyrexia, Thrombosis, Vasculitis

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax & 6 days later was real ill from then until 5MAR t100-103.5 24 hrs day; went into hosp 15NOV93; ATB for 40 days; temp cont; hosp 16FEB-26; vasculitis from virus; 4MAY blood clot; no sx of cold or illness until took flu shot


Changed on 2/14/2017

VAERS ID: 63043 Before After
VAERS Form:
Age:64.6 64.0
Sex:Male
Location:Mississippi
Vaccinated:1993-10-14
Onset:1993-10-21
Submitted:1994-05-17
Entered:1994-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41016 / 0 A / -

Administered by: Unknown      Purchased by: Public
Symptoms: Infection, Pyrexia, Thrombosis, Vasculitis

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax & 6 days later was real ill from then until 5MAR t100-103.5 24 hrs day; went into hosp 15NOV93; ATB for 40 days; temp cont; hosp 16FEB-26; vasculitis from virus; 4MAY blood clot; no sx of cold or illness until took flu shot


Changed on 5/14/2017

VAERS ID: 63043 Before After
VAERS Form:
Age:64.0
Sex:Male
Location:Mississippi
Vaccinated:1993-10-14
Onset:1993-10-21
Submitted:1994-05-17
Entered:1994-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41016 / 0 A - / - A

Administered by: Unknown      Purchased by: Public
Symptoms: Infection, Pyrexia, Thrombosis, Vasculitis

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax & 6 days later was real ill from then until 5MAR t100-103.5 24 hrs day; went into hosp 15NOV93; ATB for 40 days; temp cont; hosp 16FEB-26; vasculitis from virus; 4MAY blood clot; no sx of cold or illness until took flu shot


Changed on 9/14/2017

VAERS ID: 63043 Before After
VAERS Form:(blank) 1
Age:64.0
Sex:Male
Location:Mississippi
Vaccinated:1993-10-14
Onset:1993-10-21
Submitted:1994-05-17
Entered:1994-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41016 / 0 1 - / A

Administered by: Unknown      Purchased by: Public
Symptoms: Infection, Pyrexia, Thrombosis, Vasculitis

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax & 6 days later was real ill from then until 5MAR t100-103.5 24 hrs day; went into hosp 15NOV93; ATB for 40 days; temp cont; hosp 16FEB-26; vasculitis from virus; 4MAY blood clot; no sx of cold or illness until took flu shot


Changed on 2/14/2018

VAERS ID: 63043 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Mississippi
Vaccinated:1993-10-14
Onset:1993-10-21
Submitted:1994-05-17
Entered:1994-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41016 / 1 - / A

Administered by: Unknown      Purchased by: Public
Symptoms: Infection, Pyrexia, Thrombosis, Vasculitis

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax & 6 days later was real ill from then until 5MAR t100-103.5 24 hrs day; went into hosp 15NOV93; ATB for 40 days; temp cont; hosp 16FEB-26; vasculitis from virus; 4MAY blood clot; no sx of cold or illness until took flu shot


Changed on 6/14/2018

VAERS ID: 63043 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Mississippi
Vaccinated:1993-10-14
Onset:1993-10-21
Submitted:1994-05-17
Entered:1994-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41016 / 1 - / A

Administered by: Unknown      Purchased by: Public
Symptoms: Infection, Pyrexia, Thrombosis, Vasculitis

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax & 6 days later was real ill from then until 5MAR t100-103.5 24 hrs day; went into hosp 15NOV93; ATB for 40 days; temp cont; hosp 16FEB-26; vasculitis from virus; 4MAY blood clot; no sx of cold or illness until took flu shot


Changed on 8/14/2018

VAERS ID: 63043 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Mississippi
Vaccinated:1993-10-14
Onset:1993-10-21
Submitted:1994-05-17
Entered:1994-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41016 / 1 - / A

Administered by: Unknown      Purchased by: Public
Symptoms: Infection, Pyrexia, Thrombosis, Vasculitis

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax & 6 days later was real ill from then until 5MAR t100-103.5 24 hrs day; went into hosp 15NOV93; ATB for 40 days; temp cont; hosp 16FEB-26; vasculitis from virus; 4MAY blood clot; no sx of cold or illness until took flu shot


Changed on 9/14/2018

VAERS ID: 63043 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Mississippi
Vaccinated:1993-10-14
Onset:1993-10-21
Submitted:1994-05-17
Entered:1994-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41016 / 1 - / A

Administered by: Unknown      Purchased by: Public
Symptoms: Infection, Pyrexia, Thrombosis, Vasculitis

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax & 6 days later was real ill from then until 5MAR t100-103.5 24 hrs day; went into hosp 15NOV93; ATB for 40 days; temp cont; hosp 16FEB-26; vasculitis from virus; 4MAY blood clot; no sx of cold or illness until took flu shot


Changed on 10/14/2018

VAERS ID: 63043 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Mississippi
Vaccinated:1993-10-14
Onset:1993-10-21
Submitted:1994-05-17
Entered:1994-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41016 / 1 - / A

Administered by: Unknown      Purchased by: Public
Symptoms: Infection, Pyrexia, Thrombosis, Vasculitis

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd flu vax & 6 days later was real ill from then until 5MAR t100-103.5 24 hrs day; went into hosp 15NOV93; ATB for 40 days; temp cont; hosp 16FEB-26; vasculitis from virus; 4MAY blood clot; no sx of cold or illness until took flu shot

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=63043&WAYBACKHISTORY=ON


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