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This is VAERS ID 36651

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36651
VAERS Form:
Age:69.9
Gender:Female
Location:Utah
Vaccinated:1991-10-16
Onset:1991-10-16
Submitted:1991-11-01
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1991-1992 / CONNAUGHT LABS 1F21216 / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, ASTHMA, TACHYCARDIA, HYPERTENS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Micronase
Current Illness: NONE
Preexisting Conditions: PCN allergy (no allergy to eggs)- diabetes
Allergies:
Diagnostic Lab Data: EKG-normal-lt on moniter until AM;
CDC 'Split Type':

Write-up: 1st noticed elevated temp then rapid heart rate becoming more pronounced; went to ER about 1230AM; 17OCT91 w/inc temp, inc HR, inc BP & wheezing; EKG done; given DPH & APAP sx resolved but admitted for observatin until next AM;


Changed on 12/8/2009

VAERS ID: 36651 Before After
VAERS Form:
Age:69.9
Gender:Female
Location:Utah
Vaccinated:1991-10-16
Onset:1991-10-16
Submitted:1991-11-01
Entered:1991-12-03 1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1991-1992 INFLUENZA (SEASONAL) (FLUZONE 91-92) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1F21216 / - LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Asthma, Hypertension, Pyrexia, Tachycardia, FEVER, ASTHMA, TACHYCARDIA, HYPERTENS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Micronase
Current Illness: NONE
Preexisting Conditions: PCN allergy (no allergy to eggs)- diabetes
Allergies:
Diagnostic Lab Data: EKG-normal-lt on moniter until AM;
CDC 'Split Type': (blank) UT9126

Write-up: 1st noticed elevated temp then rapid heart rate becoming more pronounced; went to ER about 1230AM; 17OCT91 w/inc temp, inc HR, inc BP & wheezing; EKG done; given DPH & APAP sx resolved but admitted for observatin until next AM;


Changed on 8/31/2010

VAERS ID: 36651 Before After
VAERS Form:
Age:69.9
Gender:Female
Location:Utah
Vaccinated:1991-10-16
Onset:1991-10-16
Submitted:1991-11-01
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 91-92) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Hypertension, Pyrexia, Tachycardia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Micronase
Current Illness: NONE
Preexisting Conditions: PCN allergy (no allergy to eggs)- diabetes
Allergies:
Diagnostic Lab Data: EKG-normal-lt on moniter until AM;
CDC 'Split Type': UT9126

Write-up: 1st noticed elevated temp then rapid heart rate becoming more pronounced; went to ER about 1230AM; 17OCT91 w/inc temp, inc HR, inc BP & wheezing; EKG done; given DPH & APAP sx resolved but admitted for observatin until next AM;


Changed on 7/7/2013

VAERS ID: 36651 Before After
VAERS Form:
Age:69.9
Gender:Female
Location:Utah
Vaccinated:1991-10-16
Onset:1991-10-16
Submitted:1991-11-01
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Hypertension, Pyrexia, Tachycardia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Micronase
Current Illness: NONE
Preexisting Conditions: PCN allergy (no allergy to eggs)- diabetes
Allergies:
Diagnostic Lab Data: EKG-normal-lt on moniter until AM;
CDC 'Split Type': UT9126

Write-up: 1st noticed elevated temp then rapid heart rate becoming more pronounced; went to ER about 1230AM; 17OCT91 w/inc temp, inc HR, inc BP & wheezing; EKG done; given DPH & APAP sx resolved but admitted for observatin until next AM;


Changed on 2/14/2017

VAERS ID: 36651 Before After
VAERS Form:
Age:69.9 69.0
Gender:Female
Location:Utah
Vaccinated:1991-10-16
Onset:1991-10-16
Submitted:1991-11-01
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Hypertension, Pyrexia, Tachycardia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Micronase
Current Illness: NONE
Preexisting Conditions: PCN allergy (no allergy to eggs)- diabetes
Allergies:
Diagnostic Lab Data: EKG-normal-lt on moniter until AM;
CDC 'Split Type': UT9126

Write-up: 1st noticed elevated temp then rapid heart rate becoming more pronounced; went to ER about 1230AM; 17OCT91 w/inc temp, inc HR, inc BP & wheezing; EKG done; given DPH & APAP sx resolved but admitted for observatin until next AM;


Changed on 5/14/2017

VAERS ID: 36651 Before After
VAERS Form:
Age:69.0
Gender:Female
Location:Utah
Vaccinated:1991-10-16
Onset:1991-10-16
Submitted:1991-11-01
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / - LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Hypertension, Pyrexia, Tachycardia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Micronase
Current Illness: NONE
Preexisting Conditions: PCN allergy (no allergy to eggs)- diabetes
Allergies:
Diagnostic Lab Data: EKG-normal-lt on moniter until AM;
CDC 'Split Type': UT9126

Write-up: 1st noticed elevated temp then rapid heart rate becoming more pronounced; went to ER about 1230AM; 17OCT91 w/inc temp, inc HR, inc BP & wheezing; EKG done; given DPH & APAP sx resolved but admitted for observatin until next AM;


Changed on 9/14/2017

VAERS ID: 36651 Before After
VAERS Form:(blank) 1
Age:69.0
Gender:Female
Location:Utah
Vaccinated:1991-10-16
Onset:1991-10-16
Submitted:1991-11-01
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / - UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Hypertension, Pyrexia, Tachycardia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Micronase
Current Illness: NONE
Preexisting Conditions: PCN allergy (no allergy to eggs)- diabetes
Allergies:
Diagnostic Lab Data: EKG-normal-lt on moniter until AM;
CDC 'Split Type': UT9126

Write-up: 1st noticed elevated temp then rapid heart rate becoming more pronounced; went to ER about 1230AM; 17OCT91 w/inc temp, inc HR, inc BP & wheezing; EKG done; given DPH & APAP sx resolved but admitted for observatin until next AM;


Changed on 2/14/2018

VAERS ID: 36651 Before After
VAERS Form:1
Age:69.0
Gender:Female
Location:Utah
Vaccinated:1991-10-16
Onset:1991-10-16
Submitted:1991-11-01
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Hypertension, Pyrexia, Tachycardia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Micronase
Current Illness: NONE
Preexisting Conditions: PCN allergy (no allergy to eggs)- diabetes
Allergies:
Diagnostic Lab Data: EKG-normal-lt on moniter until AM;
CDC 'Split Type': UT9126

Write-up: 1st noticed elevated temp then rapid heart rate becoming more pronounced; went to ER about 1230AM; 17OCT91 w/inc temp, inc HR, inc BP & wheezing; EKG done; given DPH & APAP sx resolved but admitted for observatin until next AM;


Changed on 6/14/2018

VAERS ID: 36651 Before After
VAERS Form:1
Age:69.0
Gender:Female
Location:Utah
Vaccinated:1991-10-16
Onset:1991-10-16
Submitted:1991-11-01
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Hypertension, Pyrexia, Tachycardia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Micronase
Current Illness: NONE
Preexisting Conditions: PCN allergy (no allergy to eggs)- diabetes
Allergies:
Diagnostic Lab Data: EKG-normal-lt on moniter until AM;
CDC 'Split Type': UT9126

Write-up: 1st noticed elevated temp then rapid heart rate becoming more pronounced; went to ER about 1230AM; 17OCT91 w/inc temp, inc HR, inc BP & wheezing; EKG done; given DPH & APAP sx resolved but admitted for observatin until next AM;


Changed on 8/14/2018

VAERS ID: 36651 Before After
VAERS Form:1
Age:69.0
Gender:Female
Location:Utah
Vaccinated:1991-10-16
Onset:1991-10-16
Submitted:1991-11-01
Entered:1991-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21216 / UNK LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Hypertension, Pyrexia, Tachycardia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Micronase
Current Illness: NONE
Preexisting Conditions: PCN allergy (no allergy to eggs)- diabetes
Allergies:
Diagnostic Lab Data: EKG-normal-lt on moniter until AM;
CDC 'Split Type': UT9126

Write-up: 1st noticed elevated temp then rapid heart rate becoming more pronounced; went to ER about 1230AM; 17OCT91 w/inc temp, inc HR, inc BP & wheezing; EKG done; given DPH & APAP sx resolved but admitted for observatin until next AM;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=36651&WAYBACKHISTORY=ON


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