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This is VAERS ID 69049

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 69049
VAERS Form:
Age:23.5
Sex:Female
Location:Maryland
Vaccinated:1994-10-19
Onset:1994-10-20
Submitted:1994-11-02
Entered:1994-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1994-1995 / WYETH 4948125 / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, HEMATURIA, GLOMERULITIS, CREATININE INC, ANURIA

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC 'Split Type':

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;


Changed on 12/8/2009

VAERS ID: 69049 Before After
VAERS Form:
Age:23.5
Sex:Female
Location:Maryland
Vaccinated:1994-10-19
Onset:1994-10-20
Submitted:1994-11-02
Entered:1994-12-06 1994-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1994-1995 INFLUENZA (SEASONAL) (FLUSHIELD 94-95) / WYETH WYETH PHARMACEUTICALS, INC 4948125 / - - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Anuria, Blood creatinine increased, Glomerulonephritis, Haematuria, Immune system disorder, Laboratory test abnormal, Pyrexia, Serum sickness, FEVER, HEMATURIA, GLOMERULITIS, CREATININE INC, ANURIA

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC 'Split Type': (blank) 894312004K

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;


Changed on 8/31/2010

VAERS ID: 69049 Before After
VAERS Form:
Age:23.5
Sex:Female
Location:Maryland
Vaccinated:1994-10-19
Onset:1994-10-20
Submitted:1994-11-02
Entered:1994-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 94-95) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4948125 / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Anuria, Blood creatinine increased, Glomerulonephritis, Haematuria, Immune system disorder, Laboratory test abnormal, Pyrexia, Serum sickness

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC 'Split Type': 894312004K

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;


Changed on 7/7/2013

VAERS ID: 69049 Before After
VAERS Form:
Age:23.5
Sex:Female
Location:Maryland
Vaccinated:1994-10-19
Onset:1994-10-20
Submitted:1994-11-02
Entered:1994-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948125 / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948125 / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Anuria, Blood creatinine increased, Glomerulonephritis, Haematuria, Immune system disorder, Laboratory test abnormal, Pyrexia, Serum sickness

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC 'Split Type': 894312004K

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;


Changed on 2/14/2017

VAERS ID: 69049 Before After
VAERS Form:
Age:23.5 23.0
Sex:Female
Location:Maryland
Vaccinated:1994-10-19
Onset:1994-10-20
Submitted:1994-11-02
Entered:1994-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948125 / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Anuria, Blood creatinine increased, Glomerulonephritis, Haematuria, Immune system disorder, Laboratory test abnormal, Pyrexia, Serum sickness

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC 'Split Type': 894312004K

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;


Changed on 5/14/2017

VAERS ID: 69049 Before After
VAERS Form:
Age:23.0
Sex:Female
Location:Maryland
Vaccinated:1994-10-19
Onset:1994-10-20
Submitted:1994-11-02
Entered:1994-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948125 / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Anuria, Blood creatinine increased, Glomerulonephritis, Haematuria, Immune system disorder, Laboratory test abnormal, Pyrexia, Serum sickness

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: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC 'Split Type': 894312004K

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;


Changed on 9/14/2017

VAERS ID: 69049 Before After
VAERS Form:(blank) 1
Age:23.0
Sex:Female
Location:Maryland
Vaccinated:1994-10-19
Onset:1994-10-20
Submitted:1994-11-02
Entered:1994-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948125 / - UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Anuria, Blood creatinine increased, Glomerulonephritis, Haematuria, Immune system disorder, Laboratory test abnormal, Pyrexia, Serum sickness

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: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC 'Split Type': 894312004K

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;


Changed on 2/14/2018

VAERS ID: 69049 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Maryland
Vaccinated:1994-10-19
Onset:1994-10-20
Submitted:1994-11-02
Entered:1994-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948125 / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Anuria, Blood creatinine increased, Glomerulonephritis, Haematuria, Immune system disorder, Laboratory test abnormal, Pyrexia, Serum sickness

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: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC 'Split Type': 894312004K

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;


Changed on 6/14/2018

VAERS ID: 69049 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Maryland
Vaccinated:1994-10-19
Onset:1994-10-20
Submitted:1994-11-02
Entered:1994-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948125 / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Anuria, Blood creatinine increased, Glomerulonephritis, Haematuria, Immune system disorder, Laboratory test abnormal, Pyrexia, Serum sickness

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: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC 'Split Type': 894312004K

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;


Changed on 8/14/2018

VAERS ID: 69049 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Maryland
Vaccinated:1994-10-19
Onset:1994-10-20
Submitted:1994-11-02
Entered:1994-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948125 / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Anuria, Blood creatinine increased, Glomerulonephritis, Haematuria, Immune system disorder, Laboratory test abnormal, Pyrexia, Serum sickness

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: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC 'Split Type': 894312004K

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;


Changed on 9/14/2018

VAERS ID: 69049 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Maryland
Vaccinated:1994-10-19
Onset:1994-10-20
Submitted:1994-11-02
Entered:1994-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948125 / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Anuria, Blood creatinine increased, Glomerulonephritis, Haematuria, Immune system disorder, Laboratory test abnormal, Pyrexia, Serum sickness

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: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC 'Split Type': 894312004K

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;


Changed on 10/14/2018

VAERS ID: 69049 Before After
VAERS Form:1
Age:23.0
Sex:Female
Location:Maryland
Vaccinated:1994-10-19
Onset:1994-10-20
Submitted:1994-11-02
Entered:1994-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948125 / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Anuria, Blood creatinine increased, Glomerulonephritis, Haematuria, Immune system disorder, Laboratory test abnormal, Pyrexia, Serum sickness

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: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC 'Split Type': 894312004K

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=69049&WAYBACKHISTORY=ON


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