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This is VAERS ID 91307

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 91307
VAERS Form:
Age:42.1
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: EDEMA INJECT SITE, VASODILAT

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 12/8/2009

VAERS ID: 91307 Before After
VAERS Form:
Age:42.1
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-31 1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Other      Purchased by: Unknown Public
Symptoms: Injection site oedema, Vasodilatation, EDEMA INJECT SITE, VASODILAT

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 7/7/2013

VAERS ID: 91307 Before After
VAERS Form:
Age:42.1
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 12/14/2016

VAERS ID: 91307 Before After
VAERS Form:
Age:42.1
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 2/14/2017

VAERS ID: 91307 Before After
VAERS Form:
Age:42.1 42.0
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 5/14/2017

VAERS ID: 91307 Before After
VAERS Form:
Age:42.0
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 9/14/2017

VAERS ID: 91307 Before After
VAERS Form:(blank) 1
Age:42.0
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 2/14/2018

VAERS ID: 91307 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 6/14/2018

VAERS ID: 91307 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 8/14/2018

VAERS ID: 91307 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 9/14/2018

VAERS ID: 91307 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 10/14/2018

VAERS ID: 91307 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 12/24/2020

VAERS ID: 91307 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 12/30/2020

VAERS ID: 91307 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 5/7/2021

VAERS ID: 91307 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;


Changed on 5/14/2021

VAERS ID: 91307 Before After
VAERS Form:1
Age:42.0
Sex:Female
Location:New Jersey
Vaccinated:1996-10-15
Onset:1996-10-17
Submitted:1996-10-19
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Injection site oedema, Vasodilatation

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: Prozac
Current Illness: NONE
Preexisting Conditions: pollen-fragile X synd
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt exp swelling @ inj site, warm @ inj site;pt perm disabled w/fragile x synd;

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