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This is VAERS ID 104490

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 104490
VAERS Form:
Age:55.6
Sex:Female
Location:Georgia
Vaccinated:1996-11-01
Onset:1996-11-08
Submitted:1997-09-10
Entered:1997-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1996-1997 / MEDEVA PHARMS LI E3036GA / - RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: ANA, HEADACHE, NEUROPATHY, PAIN, CEREBROVASC ACCID

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;


Changed on 12/8/2009

VAERS ID: 104490 Before After
VAERS Form:
Age:55.6
Sex:Female
Location:Georgia
Vaccinated:1996-11-01
Onset:1996-11-08
Submitted:1997-09-10
Entered:1997-11-12 1997-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1996-1997 INFLUENZA (SEASONAL) (FLUVIRIN 96-97) / MEDEVA PHARMS LI MEDEVA PHARMA, LTD. E3036GA / - RA / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: ANA, Antinuclear antibody, Cerebrovascular accident, Condition aggravated, Headache, Neuropathy, Pain, Paraesthesia, Visual disturbance, HEADACHE, NEUROPATHY, PAIN, CEREBROVASC ACCID

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': (blank) GA97124

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;


Changed on 8/31/2010

VAERS ID: 104490 Before After
VAERS Form:
Age:55.6
Sex:Female
Location:Georgia
Vaccinated:1996-11-01
Onset:1996-11-08
Submitted:1997-09-10
Entered:1997-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN 96-97) INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3036GA / - RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Antinuclear antibody, Cerebrovascular accident, Condition aggravated, Headache, Neuropathy, Pain, Paraesthesia, Visual disturbance

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': GA97124

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;


Changed on 7/7/2013

VAERS ID: 104490 Before After
VAERS Form:
Age:55.6
Sex:Female
Location:Georgia
Vaccinated:1996-11-01
Onset:1996-11-08
Submitted:1997-09-10
Entered:1997-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3036GA / - RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3036GA / - RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Antinuclear antibody, Cerebrovascular accident, Condition aggravated, Headache, Neuropathy, Pain, Paraesthesia, Visual disturbance

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': GA97124

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;


Changed on 2/14/2017

VAERS ID: 104490 Before After
VAERS Form:
Age:55.6 55.0
Sex:Female
Location:Georgia
Vaccinated:1996-11-01
Onset:1996-11-08
Submitted:1997-09-10
Entered:1997-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3036GA / - RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Antinuclear antibody, Cerebrovascular accident, Condition aggravated, Headache, Neuropathy, Pain, Paraesthesia, Visual disturbance

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': GA97124

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;


Changed on 5/14/2017

VAERS ID: 104490 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:Georgia
Vaccinated:1996-11-01
Onset:1996-11-08
Submitted:1997-09-10
Entered:1997-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3036GA / - RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Antinuclear antibody, Cerebrovascular accident, Condition aggravated, Headache, Neuropathy, Pain, Paraesthesia, Visual disturbance

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': GA97124

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;


Changed on 9/14/2017

VAERS ID: 104490 Before After
VAERS Form:(blank) 1
Age:55.0
Sex:Female
Location:Georgia
Vaccinated:1996-11-01
Onset:1996-11-08
Submitted:1997-09-10
Entered:1997-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3036GA / - UNK RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Antinuclear antibody, Cerebrovascular accident, Condition aggravated, Headache, Neuropathy, Pain, Paraesthesia, Visual disturbance

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': GA97124

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;


Changed on 2/14/2018

VAERS ID: 104490 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Georgia
Vaccinated:1996-11-01
Onset:1996-11-08
Submitted:1997-09-10
Entered:1997-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3036GA / UNK RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Antinuclear antibody, Cerebrovascular accident, Condition aggravated, Headache, Neuropathy, Pain, Paraesthesia, Visual disturbance

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': GA97124

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;


Changed on 6/14/2018

VAERS ID: 104490 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Georgia
Vaccinated:1996-11-01
Onset:1996-11-08
Submitted:1997-09-10
Entered:1997-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3036GA / UNK RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Antinuclear antibody, Cerebrovascular accident, Condition aggravated, Headache, Neuropathy, Pain, Paraesthesia, Visual disturbance

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': GA97124

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;


Changed on 8/14/2018

VAERS ID: 104490 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Georgia
Vaccinated:1996-11-01
Onset:1996-11-08
Submitted:1997-09-10
Entered:1997-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3036GA / UNK RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Antinuclear antibody, Cerebrovascular accident, Condition aggravated, Headache, Neuropathy, Pain, Paraesthesia, Visual disturbance

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': GA97124

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;


Changed on 9/14/2018

VAERS ID: 104490 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Georgia
Vaccinated:1996-11-01
Onset:1996-11-08
Submitted:1997-09-10
Entered:1997-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3036GA / UNK RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Antinuclear antibody, Cerebrovascular accident, Condition aggravated, Headache, Neuropathy, Pain, Paraesthesia, Visual disturbance

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': GA97124

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;


Changed on 10/14/2018

VAERS ID: 104490 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Georgia
Vaccinated:1996-11-01
Onset:1996-11-08
Submitted:1997-09-10
Entered:1997-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3036GA / UNK RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Antinuclear antibody, Cerebrovascular accident, Condition aggravated, Headache, Neuropathy, Pain, Paraesthesia, Visual disturbance

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Novolin;Insulin;Cozar
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': GA97124

Write-up: pt states on 8NOV96 pt had severe h/a-could not focus eyes-did not see MD on 18NOV97 onset of numbness lt leg, lt hand, lt side of face;saw MD was referred to MD & adm to hosp x 3 days;told had diabetic stroke;devel pain dx neuropathy;

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