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This is VAERS ID 65275

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 65275
VAERS Form:
Age:66.3
Sex:Female
Location:North Carolina
Vaccinated:1993-11-09
Onset:1993-11-09
Submitted:1994-03-17
Entered:1994-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1993-1994 / PARKE-DAVIS 00863P / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: PAIN INJECT SITE, HYPERTONIA, PAIN

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:
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type':

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;


Changed on 12/8/2009

VAERS ID: 65275 Before After
VAERS Form:
Age:66.3
Sex:Female
Location:North Carolina
Vaccinated:1993-11-09
Onset:1993-11-09
Submitted:1994-03-17
Entered:1994-08-25 1994-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1993-1994 INFLUENZA (SEASONAL) (FLUOGEN 93-94) / PARKE-DAVIS 00863P / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Hypertonia, Injection site pain, Pain, PAIN INJECT SITE, HYPERTONIA, PAIN

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:
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': (blank) 29249

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;


Changed on 8/31/2010

VAERS ID: 65275 Before After
VAERS Form:
Age:66.3
Sex:Female
Location:North Carolina
Vaccinated:1993-11-09
Onset:1993-11-09
Submitted:1994-03-17
Entered:1994-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 93-94) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Hypertonia, Injection site pain, Pain

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:
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 29249

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;


Changed on 7/7/2013

VAERS ID: 65275 Before After
VAERS Form:
Age:66.3
Sex:Female
Location:North Carolina
Vaccinated:1993-11-09
Onset:1993-11-09
Submitted:1994-03-17
Entered:1994-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Hypertonia, Injection site pain, Pain

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:
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 29249

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;


Changed on 2/14/2017

VAERS ID: 65275 Before After
VAERS Form:
Age:66.3 66.0
Sex:Female
Location:North Carolina
Vaccinated:1993-11-09
Onset:1993-11-09
Submitted:1994-03-17
Entered:1994-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Hypertonia, Injection site pain, Pain

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:
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 29249

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;


Changed on 5/14/2017

VAERS ID: 65275 Before After
VAERS Form:
Age:66.0
Sex:Female
Location:North Carolina
Vaccinated:1993-11-09
Onset:1993-11-09
Submitted:1994-03-17
Entered:1994-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Hypertonia, Injection site pain, Pain

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: ~ ()~~~In patient
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 29249

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;


Changed on 9/14/2017

VAERS ID: 65275 Before After
VAERS Form:(blank) 1
Age:66.0
Sex:Female
Location:North Carolina
Vaccinated:1993-11-09
Onset:1993-11-09
Submitted:1994-03-17
Entered:1994-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / - UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Hypertonia, Injection site pain, Pain

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: ~ ()~~~In patient
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 29249

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;


Changed on 2/14/2018

VAERS ID: 65275 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:North Carolina
Vaccinated:1993-11-09
Onset:1993-11-09
Submitted:1994-03-17
Entered:1994-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Hypertonia, Injection site pain, Pain

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: ~ ()~~~In patient
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 29249

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;


Changed on 6/14/2018

VAERS ID: 65275 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:North Carolina
Vaccinated:1993-11-09
Onset:1993-11-09
Submitted:1994-03-17
Entered:1994-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Hypertonia, Injection site pain, Pain

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: ~ ()~~~In patient
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 29249

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;


Changed on 8/14/2018

VAERS ID: 65275 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:North Carolina
Vaccinated:1993-11-09
Onset:1993-11-09
Submitted:1994-03-17
Entered:1994-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Hypertonia, Injection site pain, Pain

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: ~ ()~~~In patient
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 29249

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;


Changed on 9/14/2018

VAERS ID: 65275 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:North Carolina
Vaccinated:1993-11-09
Onset:1993-11-09
Submitted:1994-03-17
Entered:1994-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Hypertonia, Injection site pain, Pain

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: ~ ()~~~In patient
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 29249

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;


Changed on 10/14/2018

VAERS ID: 65275 Before After
VAERS Form:1
Age:66.0
Sex:Female
Location:North Carolina
Vaccinated:1993-11-09
Onset:1993-11-09
Submitted:1994-03-17
Entered:1994-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00863P / UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Hypertonia, Injection site pain, Pain

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: ~ ()~~~In patient
Other Medications: Vasotec, hydrochlorothiazide;
Current Illness: none
Preexisting Conditions: hypertension, hypercholesterolemia, adult diabetes mellitus;
Allergies:
Diagnostic Lab Data: n/s
CDC 'Split Type': 29249

Write-up: pt recvd flu vax 9NOV93 & had pain in lt arm when lifted the arm; pt''s husband reported arm pain still persists; pt''s arm was x-rayed;

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=65275&WAYBACKHISTORY=ON


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