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This is VAERS ID 69641

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 69641
VAERS Form:
Age:49.2
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1994-1995 / CONNAUGHT LABS 3J41019 / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: ECCHYMOSIS, PETECHIA, PURPURA THROMBOPEN, EPISTAXIS

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type': allergies to milk,foods;tx w/ shots 10 years previously;

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


Changed on 12/8/2009

VAERS ID: 69641 Before After
VAERS Form:
Age:49.2
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-23 1994-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1994-1995 INFLUENZA (SEASONAL) (FLUZONE 94-95) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3J41019 / - - / -

Administered by: Other      Purchased by: Unknown Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura, ECCHYMOSIS, PETECHIA, PURPURA THROMBOPEN, EPISTAXIS

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type': allergies to milk,foods;tx w/ shots 10 years previously;

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


Changed on 8/31/2010

VAERS ID: 69641 Before After
VAERS Form:
Age:49.2
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 94-95) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / - - / -

Administered by: Other      Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type': allergies to milk,foods;tx w/ shots 10 years previously;

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


Changed on 10/14/2012

VAERS ID: 69641 Before After
VAERS Form:
Age:49.2
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / - - / -

Administered by: Other      Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type': allergies to milk,foods;tx w/ shots 10 years previously; (blank)

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


Changed on 7/7/2013

VAERS ID: 69641 Before After
VAERS Form:
Age:49.2
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / - - / -

Administered by: Other      Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type':

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


Changed on 2/14/2017

VAERS ID: 69641 Before After
VAERS Form:
Age:49.2 49.0
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / - - / -

Administered by: Other      Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type':

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


Changed on 5/14/2017

VAERS ID: 69641 Before After
VAERS Form:
Age:49.0
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / - - / -

Administered by: Other      Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn; pcn;~ ()~~~In patient
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type':

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


Changed on 9/14/2017

VAERS ID: 69641 Before After
VAERS Form:(blank) 1
Age:49.0
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / - UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;~ ()~~~In patient
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type':

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


Changed on 2/14/2018

VAERS ID: 69641 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;~ ()~~~In patient
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type':

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


Changed on 6/14/2018

VAERS ID: 69641 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;~ ()~~~In patient
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type':

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


Changed on 8/14/2018

VAERS ID: 69641 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;~ ()~~~In patient
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type':

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


Changed on 9/14/2018

VAERS ID: 69641 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;~ ()~~~In patient
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type':

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


Changed on 10/14/2018

VAERS ID: 69641 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Maryland
Vaccinated:1993-11-02
Onset:1994-01-06
Submitted:1994-11-27
Entered:1994-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / UNK - / -

Administered by: Other      Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura

Life Threatening? Yes
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? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;~ ()~~~In patient
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC 'Split Type':

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;

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