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This is VAERS ID 92042

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 92042
VAERS Form:
Age:19.9
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1996-1997 / WYETH - / - - / -
HEPA: UNK. HEPATITIS A / UNCLASSIFIED - / - - / -
TYP: TYPHOID / WYETH - / - - / -

Administered by: Military      Purchased by: Unknown
Symptoms: FEVER, HYPOTENS, HEADACHE, LAB TEST ABNORM, NAUSEA VOMIT

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC 1.1 x 103;H/H 14/41.5, plt 133,000; 42L, 3M, 54S, 1E
CDC 'Split Type':

Write-up: severe h/a, hypotension 92/23, tachycardia 140, leucopenia WBC 1.1;pt hosp for sepsis eval & tx include LP given fluid resuscitation in ER;


Changed on 12/8/2009

VAERS ID: 92042 Before After
VAERS Form:
Age:19.9
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
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 - / - - / -
HEPA: UNK. HEPATITIS A HEP A (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -
TYP: TYPHOID TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / WYETH WYETH PHARMACEUTICALS, INC - / - - / -

Administered by: Military      Purchased by: Unknown Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting, FEVER, HYPOTENS, HEADACHE, LAB TEST ABNORM, NAUSEA VOMIT

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC 1.1 x 103;H/H 14/41.5, plt 133,000; 42L, 3M, 54S, 1E
CDC 'Split Type': (blank) 896304020L

Write-up: severe h/a, hypotension 92/23, tachycardia 140, leucopenia WBC 1.1;pt hosp for sepsis eval & tx include LP given fluid resuscitation in ER;


Changed on 1/5/2010

VAERS ID: 92042 Before After
VAERS Form:
Age:19.9 19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 96-97) / WYETH PHARMACEUTICALS, INC - / - - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC - / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~ ~~In patient
Other Medications: NONE Vitamin B complex multivitamin
Current Illness: NONE unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC 1.1 x 103;H/H 14/41.5, plt 133,000; 42L, 3M, 54S, 1E initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, hypotension 92/23, tachycardia 140, leucopenia WBC 1.1;pt hosp for sepsis eval & tx include LP given fluid resuscitation fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in ER; septic shock;adm to hosp;


Changed on 8/31/2010

VAERS ID: 92042 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 96-97) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~ ~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 7/7/2013

VAERS ID: 92042 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~ ~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 6/14/2014

VAERS ID: 92042 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~ ~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 2/14/2017

VAERS ID: 92042 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~ ~~In patient
Other Medications:
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 5/14/2017

VAERS ID: 92042 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~ ~~In ()~~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 9/14/2017

VAERS ID: 92042 Before After
VAERS Form:(blank) 1
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / - UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / - UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 2/14/2018

VAERS ID: 92042 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 6/14/2018

VAERS ID: 92042 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 8/14/2018

VAERS ID: 92042 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 9/14/2018

VAERS ID: 92042 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 10/14/2018

VAERS ID: 92042 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 12/24/2020

VAERS ID: 92042 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 12/30/2020

VAERS ID: 92042 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 5/7/2021

VAERS ID: 92042 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;


Changed on 5/21/2021

VAERS ID: 92042 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:North Dakota
Vaccinated:1996-10-16
Onset:1996-10-16
Submitted:1996-10-30
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Headache, Hypotension, Laboratory test abnormal, Pyrexia, Sepsis, Shock, Tachycardia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vitamin B complex multivitamin
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: initial CBC results unk;f/u CBC results: WBX 18,000;platelets 109,000, SGOT 100;potassium 2;
CDC 'Split Type': 896304020L

Write-up: pt recv vax 16OCT95 & w/in 45min devel hypotension (80/35), tachycardia (pulse rate 100-110, resp 20), severe h/a, fever (initially 37.3 C), hypokalemia;n/v;pt acted like was in septic shock;adm to hosp;

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