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This is VAERS ID 90643

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 90643
VAERS Form:
Age:47.4
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: CHILLS, FEVER, MYALGIA, INSOMNIA, ASTHENIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 12/8/2009

VAERS ID: 90643 Before After
VAERS Form:
Age:47.4
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-15 1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence, CHILLS, FEVER, MYALGIA, INSOMNIA, ASTHENIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 7/7/2013

VAERS ID: 90643 Before After
VAERS Form:
Age:47.4
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
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: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 12/14/2016

VAERS ID: 90643 Before After
VAERS Form:
Age:47.4
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
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: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 2/14/2017

VAERS ID: 90643 Before After
VAERS Form:
Age:47.4 47.0
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 5/14/2017

VAERS ID: 90643 Before After
VAERS Form:
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 9/14/2017

VAERS ID: 90643 Before After
VAERS Form:(blank) 1
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 2/14/2018

VAERS ID: 90643 Before After
VAERS Form:1
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 6/14/2018

VAERS ID: 90643 Before After
VAERS Form:1
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 8/14/2018

VAERS ID: 90643 Before After
VAERS Form:1
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 9/14/2018

VAERS ID: 90643 Before After
VAERS Form:1
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 10/14/2018

VAERS ID: 90643 Before After
VAERS Form:1
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 12/24/2020

VAERS ID: 90643 Before After
VAERS Form:1
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 12/30/2020

VAERS ID: 90643 Before After
VAERS Form:1
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 5/7/2021

VAERS ID: 90643 Before After
VAERS Form:1
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;


Changed on 5/14/2021

VAERS ID: 90643 Before After
VAERS Form:1
Age:47.0
Sex:Female
Location:Kentucky
Vaccinated:1996-10-09
Onset:1996-10-09
Submitted:1996-10-10
Entered:1996-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Chills, Insomnia, Myalgia, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: Estrogen Transdermal
Current Illness: NONE
Preexisting Conditions: codeine allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: chills, temp, muscle ache, up all noc, lethargic & drained;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=90643&WAYBACKHISTORY=ON


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