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This is VAERS ID 104634

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 104634
VAERS Form:
Age:70.5
Sex:Female
Location:Maine
Vaccinated:1997-09-18
Onset:1997-10-14
Submitted:1997-11-11
Entered:1997-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1997-1998 / CONNAUGHT LABS 7F81854 / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: HYPOKINESIA, GUILLAIN BARRE SYND, ASTHENIA, MYASTHENIA, ATROPHY MUSCLE

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


Changed on 12/8/2009

VAERS ID: 104634 Before After
VAERS Form:
Age:70.5
Sex:Female
Location:Maine
Vaccinated:1997-09-18
Onset:1997-10-14
Submitted:1997-11-11
Entered:1997-11-14 1997-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1997-1998 INFLUENZA (SEASONAL) (FLUZONE 97-98) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7F81854 / - LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis, HYPOKINESIA, GUILLAIN BARRE SYND, ASTHENIA, MYASTHENIA, ATROPHY MUSCLE

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


Changed on 8/31/2010

VAERS ID: 104634 Before After
VAERS Form:
Age:70.5
Sex:Female
Location:Maine
Vaccinated:1997-09-18
Onset:1997-10-14
Submitted:1997-11-11
Entered:1997-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 97-98) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


Changed on 7/7/2013

VAERS ID: 104634 Before After
VAERS Form:
Age:70.5
Sex:Female
Location:Maine
Vaccinated:1997-09-18
Onset:1997-10-14
Submitted:1997-11-11
Entered:1997-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


Changed on 2/14/2017

VAERS ID: 104634 Before After
VAERS Form:
Age:70.5 70.0
Sex:Female
Location:Maine
Vaccinated:1997-09-18
Onset:1997-10-14
Submitted:1997-11-11
Entered:1997-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


Changed on 5/14/2017

VAERS ID: 104634 Before After
VAERS Form:
Age:70.0
Sex:Female
Location:Maine
Vaccinated:1997-09-18
Onset:1997-10-14
Submitted:1997-11-11
Entered:1997-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / - LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


Changed on 9/14/2017

VAERS ID: 104634 Before After
VAERS Form:(blank) 1
Age:70.0
Sex:Female
Location:Maine
Vaccinated:1997-09-18
Onset:1997-10-14
Submitted:1997-11-11
Entered:1997-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / - UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


Changed on 2/14/2018

VAERS ID: 104634 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Maine
Vaccinated:1997-09-18
Onset:1997-10-14
Submitted:1997-11-11
Entered:1997-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


Changed on 6/14/2018

VAERS ID: 104634 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Maine
Vaccinated:1997-09-18
Onset:1997-10-14
Submitted:1997-11-11
Entered:1997-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


Changed on 8/14/2018

VAERS ID: 104634 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Maine
Vaccinated:1997-09-18
Onset:1997-10-14
Submitted:1997-11-11
Entered:1997-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


Changed on 9/14/2018

VAERS ID: 104634 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Maine
Vaccinated:1997-09-18
Onset:1997-10-14
Submitted:1997-11-11
Entered:1997-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


Changed on 10/14/2018

VAERS ID: 104634 Before After
VAERS Form:1
Age:70.0
Sex:Female
Location:Maine
Vaccinated:1997-09-18
Onset:1997-10-14
Submitted:1997-11-11
Entered:1997-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / UNK LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;

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