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This is VAERS ID 105113

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 105113
VAERS Form:
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1997-1998 / MEDEVA PHARMS LI E2253HA / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: PERSON DIS, GUILLAIN BARRE SYND, ASTHENIA, ATAXIA, REACT AGGRAV

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: 90     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 12/8/2009

VAERS ID: 105113 Before After
VAERS Form:
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-26 1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1997-1998 INFLUENZA (SEASONAL) (FLUVIRIN 97-98) / MEDEVA PHARMS LI MEDEVA PHARMA, LTD. E2253HA / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder, PERSON DIS, GUILLAIN BARRE SYND, ASTHENIA, ATAXIA, REACT AGGRAV

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: 90     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 8/31/2010

VAERS ID: 105113 Before After
VAERS Form:
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN 97-98) INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 7/7/2013

VAERS ID: 105113 Before After
VAERS Form:
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 5/14/2017

VAERS ID: 105113 Before After
VAERS Form:
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 9/14/2017

VAERS ID: 105113 Before After
VAERS Form:(blank) 1
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 2/14/2018

VAERS ID: 105113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 6/14/2018

VAERS ID: 105113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 8/14/2018

VAERS ID: 105113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 9/14/2018

VAERS ID: 105113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 10/14/2018

VAERS ID: 105113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 12/24/2020

VAERS ID: 105113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 12/30/2020

VAERS ID: 105113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 5/7/2021

VAERS ID: 105113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work


Changed on 5/14/2021

VAERS ID: 105113 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:1993-11-25
Onset:0000-00-00
Submitted:1997-11-03
Entered:1997-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E2253HA / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Condition aggravated, Coordination abnormal, Guillain-Barre syndrome, Personality disorder

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: 90     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: this plaintiff may have had a prev episode of GBS
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 897308014L

Write-up: pt alleges devel GBS & suffered an aggravation of a pre-existing disease or condition;hosp for 3mo;month which was spent in ICU;22OCT96 has not recovered balance & strength;severe psychological problems which has drastically curtailed work

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