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This is VAERS ID 92049

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 12/8/2009

VAERS ID: 92049 Before After
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 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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 8/31/2010

VAERS ID: 92049 Before After
VAERS Form:
Age:70.5
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 7/7/2013

VAERS ID: 92049 Before After
VAERS Form:
Age:70.5
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 2/14/2017

VAERS ID: 92049 Before After
VAERS Form:
Age:70.5 70.0
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 5/14/2017

VAERS ID: 92049 Before After
VAERS Form:
Age:70.0
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 9/14/2017

VAERS ID: 92049 Before After
VAERS Form:(blank) 1
Age:70.0
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 2/14/2018

VAERS ID: 92049 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 6/14/2018

VAERS ID: 92049 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 8/14/2018

VAERS ID: 92049 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 9/14/2018

VAERS ID: 92049 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 10/14/2018

VAERS ID: 92049 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 12/24/2020

VAERS ID: 92049 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 12/30/2020

VAERS ID: 92049 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 5/7/2021

VAERS ID: 92049 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

Changed on 5/14/2021

VAERS ID: 92049 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:California
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;cardiac fibrillation;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp herpes lt side of face w/severe vesicles;fever & devel pain in lt ear & surrounding area;had shooting pain in lt ear & could not sleep on lt side w/face or head on pillow;tender;lt side of face swollen;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=92049&WAYBACKHISTORY=ON


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