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This is VAERS ID 100352

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 100352
VAERS Form:
Age:63.2
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1994-1995 / PARKE-DAVIS - / 1 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: NEUROPATHY, MYELITIS, PARALYSIS

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type':

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 12/8/2009

VAERS ID: 100352 Before After
VAERS Form:
Age:63.2
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-22 1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1994-1995 INFLUENZA (SEASONAL) (FLUOGEN 94-95) / PARKE-DAVIS - / 1 - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Myelitis, Neuropathy, Paralysis, NEUROPATHY, MYELITIS, PARALYSIS

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': (blank) 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 8/31/2010

VAERS ID: 100352 Before After
VAERS Form:
Age:63.2
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 94-95) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 9/12/2012

VAERS ID: 100352 Before After
VAERS Form:
Age:63.2
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': 010150970085001 1.0151E+13

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 10/14/2012

VAERS ID: 100352 Before After
VAERS Form:
Age:63.2
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': 1.0151E+13 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 7/7/2013

VAERS ID: 100352 Before After
VAERS Form:
Age:63.2
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / -
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 2/14/2017

VAERS ID: 100352 Before After
VAERS Form:
Age:63.2 63.0
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 5/14/2017

VAERS ID: 100352 Before After
VAERS Form:
Age:63.0
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 9/14/2017

VAERS ID: 100352 Before After
VAERS Form:(blank) 1
Age:63.0
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 2 - / -

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 2/14/2018

VAERS ID: 100352 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 2 - / -

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 6/14/2018

VAERS ID: 100352 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 2 - / -

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 8/14/2018

VAERS ID: 100352 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 2 - / -

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 9/14/2018

VAERS ID: 100352 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 2 - / -

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


Changed on 10/14/2018

VAERS ID: 100352 Before After
VAERS Form:1
Age:63.0
Sex:Female
Location:Florida
Vaccinated:1994-09-29
Onset:1994-09-30
Submitted:1997-07-03
Entered:1997-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 2 - / -

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC 'Split Type': 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;

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