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This is VAERS ID 63926

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 63926
VAERS Form:
Age:51.7
Sex:Female
Location:Washington
Vaccinated:1989-10-30
Onset:1989-11-07
Submitted:1994-06-23
Entered:1994-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, DYSPNEA, ASTHENIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1;
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC 'Split Type': NONE

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;


Changed on 12/8/2009

VAERS ID: 63926 Before After
VAERS Form:
Age:51.7
Sex:Female
Location:Washington
Vaccinated:1989-10-30
Onset:1989-11-07
Submitted:1994-06-23
Entered:1994-07-05 1994-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Infection, INFECT, DYSPNEA, ASTHENIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1;
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC 'Split Type': NONE (blank)

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;


Changed on 7/7/2013

VAERS ID: 63926 Before After
VAERS Form:
Age:51.7
Sex:Female
Location:Washington
Vaccinated:1989-10-30
Onset:1989-11-07
Submitted:1994-06-23
Entered:1994-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1;
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC 'Split Type':

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;


Changed on 12/14/2016

VAERS ID: 63926 Before After
VAERS Form:
Age:51.7
Sex:Female
Location:Washington
Vaccinated:1989-10-30
Onset:1989-11-07
Submitted:1994-06-23
Entered:1994-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1;
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC 'Split Type':

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;


Changed on 2/14/2017

VAERS ID: 63926 Before After
VAERS Form:
Age:51.7 51.0
Sex:Female
Location:Washington
Vaccinated:1989-10-30
Onset:1989-11-07
Submitted:1994-06-23
Entered:1994-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1;
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC 'Split Type':

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;


Changed on 5/14/2017

VAERS ID: 63926 Before After
VAERS Form:
Age:51.0
Sex:Female
Location:Washington
Vaccinated:1989-10-30
Onset:1989-11-07
Submitted:1994-06-23
Entered:1994-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1; #1;~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC 'Split Type':

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;


Changed on 9/14/2017

VAERS ID: 63926 Before After
VAERS Form:(blank) 1
Age:51.0
Sex:Female
Location:Washington
Vaccinated:1989-10-30
Onset:1989-11-07
Submitted:1994-06-23
Entered:1994-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1;~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC 'Split Type':

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;


Changed on 2/14/2018

VAERS ID: 63926 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:Washington
Vaccinated:1989-10-30
Onset:1989-11-07
Submitted:1994-06-23
Entered:1994-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1;~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC 'Split Type':

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;


Changed on 6/14/2018

VAERS ID: 63926 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:Washington
Vaccinated:1989-10-30
Onset:1989-11-07
Submitted:1994-06-23
Entered:1994-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1;~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC 'Split Type':

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;


Changed on 8/14/2018

VAERS ID: 63926 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:Washington
Vaccinated:1989-10-30
Onset:1989-11-07
Submitted:1994-06-23
Entered:1994-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1;~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC 'Split Type':

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;


Changed on 9/14/2018

VAERS ID: 63926 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:Washington
Vaccinated:1989-10-30
Onset:1989-11-07
Submitted:1994-06-23
Entered:1994-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1;~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC 'Split Type':

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;


Changed on 10/14/2018

VAERS ID: 63926 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:Washington
Vaccinated:1989-10-30
Onset:1989-11-07
Submitted:1994-06-23
Entered:1994-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1;~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC 'Split Type':

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=63926&WAYBACKHISTORY=ON


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