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This is VAERS ID 670730

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2016

VAERS ID: 670730
VAERS Form:
Age:58.0
Gender:Female
Location:Vermont
Vaccinated:2016-11-21
Onset:2016-11-21
Submitted:0000-00-00
Entered:2016-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5S349 / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Skin warm

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~Influenza (Seasonal) (no brand name)~UN~56.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: None pertinent to reaction
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: 16 x 7 cm area with erythema and warmth.


Changed on 9/14/2017

VAERS ID: 670730 Before After
VAERS Form:(blank) 1
Age:58.0
Gender:Female
Location:Vermont
Vaccinated:2016-11-21
Onset:2016-11-21
Submitted:0000-00-00
Entered:2016-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5S349 / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Skin warm

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~Influenza (Seasonal) (no brand name)~UN~56.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: None pertinent to reaction
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: 16 x 7 cm area with erythema and warmth.


Changed on 2/14/2018

VAERS ID: 670730 Before After
VAERS Form:1
Age:58.0
Gender:Female
Location:Vermont
Vaccinated:2016-11-21
Onset:2016-11-21
Submitted:0000-00-00
Entered:2016-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5S349 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Skin warm

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~Influenza (Seasonal) (no brand name)~UN~56.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: None pertinent to reaction
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: 16 x 7 cm area with erythema and warmth.


Changed on 6/14/2018

VAERS ID: 670730 Before After
VAERS Form:1
Age:58.0
Gender:Female
Location:Vermont
Vaccinated:2016-11-21
Onset:2016-11-21
Submitted:0000-00-00
Entered:2016-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5S349 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Skin warm

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~Influenza (Seasonal) (no brand name)~UN~56.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: None pertinent to reaction
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: 16 x 7 cm area with erythema and warmth.


Changed on 8/14/2018

VAERS ID: 670730 Before After
VAERS Form:1
Age:58.0
Gender:Female
Location:Vermont
Vaccinated:2016-11-21
Onset:2016-11-21
Submitted:0000-00-00
Entered:2016-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5S349 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Skin warm

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~Influenza (Seasonal) (no brand name)~UN~56.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: None pertinent to reaction
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: 16 x 7 cm area with erythema and warmth.


Changed on 9/14/2018

VAERS ID: 670730 Before After
VAERS Form:1
Age:58.0
Gender:Female
Location:Vermont
Vaccinated:2016-11-21
Onset:2016-11-21
Submitted:0000-00-00
Entered:2016-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 5S349 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Skin warm

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~Influenza (Seasonal) (no brand name)~UN~56.00~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: None pertinent to reaction
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: 16 x 7 cm area with erythema and warmth.

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