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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 92049 |
VAERS Form: | |
Age: | 70.5 |
Sex: | Female |
Location: | California |
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-20 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: FLUSHIELD 1996-1997 / WYETH | 4968146 / - | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: FEVER, EDEMA FACE, INSOMNIA, PAIN, PAIN EAR
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-20 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: FLUSHIELD 1996-1997 INFLUENZA (SEASONAL) (FLUSHIELD 96-97) / WYETH WYETH PHARMACEUTICALS, INC | 4968146 / - | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia, FEVER, EDEMA FACE, INSOMNIA, PAIN, PAIN EAR
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 96-97) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | 4968146 / - | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH | 4968146 / - | LA / IM |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH | 4968146 / - | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH | 4968146 / - | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH | 4968146 / - | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH | 4968146 / - UNK | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH | 4968146 / UNK | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH | 4968146 / UNK | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH | 4968146 / UNK | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH | 4968146 / UNK | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH | 4968146 / UNK | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH | 4968146 / UNK | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
Vaccinated: | 1996-10-15 |
Onset: | 1996-10-15 |
Submitted: | 1996-10-26 |
Entered: | 1996-11-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH | 4968146 / UNK | LA / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dermatitis bullous, Ear pain, Face oedema, Insomnia, Pain, Pyrexia
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: DPH, Tamoxiphen, Inderal, multiple one a day vitamins;
Current Illness:
Preexisting Conditions: breast lumpectomy 3 1/2yr ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;
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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=92049&WAYBACKHISTORY=ON
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