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This is VAERS ID 69841

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 69841
VAERS Form:
Age:68.0
Sex:Female
Location:Georgia
Vaccinated:1994-10-13
Onset:1994-11-20
Submitted:0000-00-00
Entered:1994-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1994-1995 / WYETH 4948076 / 0 LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: SEPSIS, NEPHRITIS

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: none;
Preexisting Conditions: sepsis at onset of sxs 4-5 wks p/ inject;
Allergies:
Diagnostic Lab Data: na;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS; had sepsis on adm to hosp; may be unrelated;


Changed on 12/8/2009

VAERS ID: 69841 Before After
VAERS Form:
Age:68.0
Sex:Female
Location:Georgia
Vaccinated:1994-10-13
Onset:1994-11-20
Submitted:0000-00-00
Entered:1994-12-29 1994-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1994-1995 INFLUENZA (SEASONAL) (FLUSHIELD 94-95) / WYETH WYETH PHARMACEUTICALS, INC 4948076 / 0 LA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Nephritis, Sepsis, SEPSIS, NEPHRITIS

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: none;
Preexisting Conditions: sepsis at onset of sxs 4-5 wks p/ inject;
Allergies:
Diagnostic Lab Data: na;
CDC 'Split Type': (blank) PA9508

Write-up: pt recvd vax; devel GBS; had sepsis on adm to hosp; may be unrelated;


Changed on 8/31/2010

VAERS ID: 69841 Before After
VAERS Form:
Age:68.0
Sex:Female
Location:Georgia
Vaccinated:1994-10-13
Onset:1994-11-20
Submitted:0000-00-00
Entered:1994-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 94-95) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4948076 / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Nephritis, Sepsis

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: none;
Preexisting Conditions: sepsis at onset of sxs 4-5 wks p/ inject;
Allergies:
Diagnostic Lab Data: na;
CDC 'Split Type': PA9508

Write-up: pt recvd vax; devel GBS; had sepsis on adm to hosp; may be unrelated;


Changed on 7/7/2013

VAERS ID: 69841 Before After
VAERS Form:
Age:68.0
Sex:Female
Location:Georgia
Vaccinated:1994-10-13
Onset:1994-11-20
Submitted:0000-00-00
Entered:1994-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948076 / 0 LA / -
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948076 / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Nephritis, Sepsis

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: none;
Preexisting Conditions: sepsis at onset of sxs 4-5 wks p/ inject;
Allergies:
Diagnostic Lab Data: na;
CDC 'Split Type': PA9508

Write-up: pt recvd vax; devel GBS; had sepsis on adm to hosp; may be unrelated;


Changed on 5/14/2017

VAERS ID: 69841 Before After
VAERS Form:
Age:68.0
Sex:Female
Location:Georgia
Vaccinated:1994-10-13
Onset:1994-11-20
Submitted:0000-00-00
Entered:1994-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948076 / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Nephritis, Sepsis

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none;
Preexisting Conditions: sepsis at onset of sxs 4-5 wks p/ inject;
Allergies:
Diagnostic Lab Data: na;
CDC 'Split Type': PA9508

Write-up: pt recvd vax; devel GBS; had sepsis on adm to hosp; may be unrelated;


Changed on 9/14/2017

VAERS ID: 69841 Before After
VAERS Form:(blank) 1
Age:68.0
Sex:Female
Location:Georgia
Vaccinated:1994-10-13
Onset:1994-11-20
Submitted:0000-00-00
Entered:1994-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948076 / 0 1 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Nephritis, Sepsis

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none;
Preexisting Conditions: sepsis at onset of sxs 4-5 wks p/ inject;
Allergies:
Diagnostic Lab Data: na;
CDC 'Split Type': PA9508

Write-up: pt recvd vax; devel GBS; had sepsis on adm to hosp; may be unrelated;


Changed on 2/14/2018

VAERS ID: 69841 Before After
VAERS Form:1
Age:68.0
Sex:Female
Location:Georgia
Vaccinated:1994-10-13
Onset:1994-11-20
Submitted:0000-00-00
Entered:1994-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948076 / 1 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Nephritis, Sepsis

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none;
Preexisting Conditions: sepsis at onset of sxs 4-5 wks p/ inject;
Allergies:
Diagnostic Lab Data: na;
CDC 'Split Type': PA9508

Write-up: pt recvd vax; devel GBS; had sepsis on adm to hosp; may be unrelated;


Changed on 6/14/2018

VAERS ID: 69841 Before After
VAERS Form:1
Age:68.0
Sex:Female
Location:Georgia
Vaccinated:1994-10-13
Onset:1994-11-20
Submitted:0000-00-00
Entered:1994-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948076 / 1 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Nephritis, Sepsis

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none;
Preexisting Conditions: sepsis at onset of sxs 4-5 wks p/ inject;
Allergies:
Diagnostic Lab Data: na;
CDC 'Split Type': PA9508

Write-up: pt recvd vax; devel GBS; had sepsis on adm to hosp; may be unrelated;


Changed on 8/14/2018

VAERS ID: 69841 Before After
VAERS Form:1
Age:68.0
Sex:Female
Location:Georgia
Vaccinated:1994-10-13
Onset:1994-11-20
Submitted:0000-00-00
Entered:1994-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948076 / 1 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Nephritis, Sepsis

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none;
Preexisting Conditions: sepsis at onset of sxs 4-5 wks p/ inject;
Allergies:
Diagnostic Lab Data: na;
CDC 'Split Type': PA9508

Write-up: pt recvd vax; devel GBS; had sepsis on adm to hosp; may be unrelated;


Changed on 9/14/2018

VAERS ID: 69841 Before After
VAERS Form:1
Age:68.0
Sex:Female
Location:Georgia
Vaccinated:1994-10-13
Onset:1994-11-20
Submitted:0000-00-00
Entered:1994-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948076 / 1 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Nephritis, Sepsis

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none;
Preexisting Conditions: sepsis at onset of sxs 4-5 wks p/ inject;
Allergies:
Diagnostic Lab Data: na;
CDC 'Split Type': PA9508

Write-up: pt recvd vax; devel GBS; had sepsis on adm to hosp; may be unrelated;


Changed on 10/14/2018

VAERS ID: 69841 Before After
VAERS Form:1
Age:68.0
Sex:Female
Location:Georgia
Vaccinated:1994-10-13
Onset:1994-11-20
Submitted:0000-00-00
Entered:1994-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948076 / 1 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Nephritis, Sepsis

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none;
Preexisting Conditions: sepsis at onset of sxs 4-5 wks p/ inject;
Allergies:
Diagnostic Lab Data: na;
CDC 'Split Type': PA9508

Write-up: pt recvd vax; devel GBS; had sepsis on adm to hosp; may be unrelated;

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