National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 104867

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 104867
VAERS Form:
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1997-1998 / CONNAUGHT LABS 7F81755 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 12/8/2009

VAERS ID: 104867 Before After
VAERS Form:
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-21 1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1997-1998 INFLUENZA (SEASONAL) (FLUZONE 97-98) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7F81755 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, GUILLAIN BARRE SYND

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 8/31/2010

VAERS ID: 104867 Before After
VAERS Form:
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 97-98) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 7/7/2013

VAERS ID: 104867 Before After
VAERS Form:
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 5/14/2017

VAERS ID: 104867 Before After
VAERS Form:
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 9/14/2017

VAERS ID: 104867 Before After
VAERS Form:(blank) 1
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 2/14/2018

VAERS ID: 104867 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 6/14/2018

VAERS ID: 104867 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 8/14/2018

VAERS ID: 104867 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 9/14/2018

VAERS ID: 104867 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 10/14/2018

VAERS ID: 104867 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 12/24/2020

VAERS ID: 104867 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 12/30/2020

VAERS ID: 104867 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 5/7/2021

VAERS ID: 104867 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;


Changed on 5/14/2021

VAERS ID: 104867 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Missouri
Vaccinated:1997-10-27
Onset:1997-10-27
Submitted:1997-11-02
Entered:1997-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81755 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC 'Split Type':

Write-up: Guillain-Barre synd;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=104867&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166