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This is VAERS ID 95639

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 95639
VAERS Form:
Age:72.3
Sex:Female
Location:Georgia
Vaccinated:1996-09-01
Onset:1996-12-01
Submitted:1997-03-06
Entered:1997-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1996-1997 / PARKE-DAVIS - / 0 A / IM

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, RHINITIS, FLU SYND, SINUSITIS, PAROSMIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;


Changed on 12/8/2009

VAERS ID: 95639 Before After
VAERS Form:
Age:72.3
Sex:Female
Location:Georgia
Vaccinated:1996-09-01
Onset:1996-12-01
Submitted:1997-03-06
Entered:1997-03-17 1997-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1996-1997 INFLUENZA (SEASONAL) (FLUOGEN 96-97) / PARKE-DAVIS - / 0 A / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Ageusia, Infection, Influenza, Parosmia, Rhinitis, Sinusitis, INFECT, RHINITIS, FLU SYND, SINUSITIS, PAROSMIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 0010150970090

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;


Changed on 8/31/2010

VAERS ID: 95639 Before After
VAERS Form:
Age:72.3
Sex:Female
Location:Georgia
Vaccinated:1996-09-01
Onset:1996-12-01
Submitted:1997-03-06
Entered:1997-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 96-97) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 0 A / IM

Administered by: Private      Purchased by: Private
Symptoms: Ageusia, Infection, Influenza, Parosmia, Rhinitis, Sinusitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 0010150970090

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;


Changed on 7/7/2013

VAERS ID: 95639 Before After
VAERS Form:
Age:72.3
Sex:Female
Location:Georgia
Vaccinated:1996-09-01
Onset:1996-12-01
Submitted:1997-03-06
Entered:1997-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 0 A / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 0 A / IM

Administered by: Private      Purchased by: Private
Symptoms: Ageusia, Infection, Influenza, Parosmia, Rhinitis, Sinusitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 0010150970090

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;


Changed on 2/14/2017

VAERS ID: 95639 Before After
VAERS Form:
Age:72.3 72.0
Sex:Female
Location:Georgia
Vaccinated:1996-09-01
Onset:1996-12-01
Submitted:1997-03-06
Entered:1997-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 0 A / IM

Administered by: Private      Purchased by: Private
Symptoms: Ageusia, Infection, Influenza, Parosmia, Rhinitis, Sinusitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 0010150970090

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;


Changed on 5/14/2017

VAERS ID: 95639 Before After
VAERS Form:
Age:72.0
Sex:Female
Location:Georgia
Vaccinated:1996-09-01
Onset:1996-12-01
Submitted:1997-03-06
Entered:1997-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 0 A - / IM IM A

Administered by: Private      Purchased by: Private
Symptoms: Ageusia, Infection, Influenza, Parosmia, Rhinitis, Sinusitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 0010150970090

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;


Changed on 9/14/2017

VAERS ID: 95639 Before After
VAERS Form:(blank) 1
Age:72.0
Sex:Female
Location:Georgia
Vaccinated:1996-09-01
Onset:1996-12-01
Submitted:1997-03-06
Entered:1997-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 0 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Ageusia, Infection, Influenza, Parosmia, Rhinitis, Sinusitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 0010150970090

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;


Changed on 2/14/2018

VAERS ID: 95639 Before After
VAERS Form:1
Age:72.0
Sex:Female
Location:Georgia
Vaccinated:1996-09-01
Onset:1996-12-01
Submitted:1997-03-06
Entered:1997-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Ageusia, Infection, Influenza, Parosmia, Rhinitis, Sinusitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 0010150970090

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;


Changed on 6/14/2018

VAERS ID: 95639 Before After
VAERS Form:1
Age:72.0
Sex:Female
Location:Georgia
Vaccinated:1996-09-01
Onset:1996-12-01
Submitted:1997-03-06
Entered:1997-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Ageusia, Infection, Influenza, Parosmia, Rhinitis, Sinusitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 0010150970090

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;


Changed on 8/14/2018

VAERS ID: 95639 Before After
VAERS Form:1
Age:72.0
Sex:Female
Location:Georgia
Vaccinated:1996-09-01
Onset:1996-12-01
Submitted:1997-03-06
Entered:1997-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Ageusia, Infection, Influenza, Parosmia, Rhinitis, Sinusitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 0010150970090

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;


Changed on 9/14/2018

VAERS ID: 95639 Before After
VAERS Form:1
Age:72.0
Sex:Female
Location:Georgia
Vaccinated:1996-09-01
Onset:1996-12-01
Submitted:1997-03-06
Entered:1997-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Ageusia, Infection, Influenza, Parosmia, Rhinitis, Sinusitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 0010150970090

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;


Changed on 10/14/2018

VAERS ID: 95639 Before After
VAERS Form:1
Age:72.0
Sex:Female
Location:Georgia
Vaccinated:1996-09-01
Onset:1996-12-01
Submitted:1997-03-06
Entered:1997-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Ageusia, Infection, Influenza, Parosmia, Rhinitis, Sinusitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: NONE
Preexisting Conditions: pt medical history is remarkable for phlebitis, hysterectomy & back trouble;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 0010150970090

Write-up: pt recv vax SEP96 & devel flu sx, loss of taste x/events to the present, loss of smell & sinus drainage in DEC96 & cont w/these events to present;pt states these events have affected daily living;pt to MD & given ATB;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=95639&WAYBACKHISTORY=ON


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