National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 105296

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 105296
VAERS Form:
Age:74.1
Sex:Male
Location:Florida
Vaccinated:1997-10-21
Onset:1997-11-01
Submitted:1997-11-24
Entered:1997-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1997-1998 / CONNAUGHT LABS 7F81894 / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND, ASTHENIA, CSF ABNORM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC 'Split Type':

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


Changed on 12/8/2009

VAERS ID: 105296 Before After
VAERS Form:
Age:74.1
Sex:Male
Location:Florida
Vaccinated:1997-10-21
Onset:1997-11-01
Submitted:1997-11-24
Entered:1997-12-03 1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1997-1998 INFLUENZA (SEASONAL) (FLUZONE 97-98) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7F81894 / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Guillain-Barre syndrome, CSF test abnormal, GUILLAIN BARRE SYND, ASTHENIA, CSF ABNORM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC 'Split Type':

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


Changed on 8/31/2010

VAERS ID: 105296 Before After
VAERS Form:
Age:74.1
Sex:Male
Location:Florida
Vaccinated:1997-10-21
Onset:1997-11-01
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 97-98) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC 'Split Type':

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


Changed on 7/7/2013

VAERS ID: 105296 Before After
VAERS Form:
Age:74.1
Sex:Male
Location:Florida
Vaccinated:1997-10-21
Onset:1997-11-01
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC 'Split Type':

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


Changed on 2/14/2017

VAERS ID: 105296 Before After
VAERS Form:
Age:74.1 74.0
Sex:Male
Location:Florida
Vaccinated:1997-10-21
Onset:1997-11-01
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC 'Split Type':

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


Changed on 5/14/2017

VAERS ID: 105296 Before After
VAERS Form:
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1997-10-21
Onset:1997-11-01
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC 'Split Type':

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


Changed on 9/14/2017

VAERS ID: 105296 Before After
VAERS Form:(blank) 1
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1997-10-21
Onset:1997-11-01
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / - UNK LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC 'Split Type':

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


Changed on 2/14/2018

VAERS ID: 105296 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1997-10-21
Onset:1997-11-01
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / UNK LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC 'Split Type':

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


Changed on 6/14/2018

VAERS ID: 105296 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1997-10-21
Onset:1997-11-01
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / UNK LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC 'Split Type':

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


Changed on 8/14/2018

VAERS ID: 105296 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1997-10-21
Onset:1997-11-01
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / UNK LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC 'Split Type':

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


Changed on 9/14/2018

VAERS ID: 105296 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1997-10-21
Onset:1997-11-01
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / UNK LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC 'Split Type':

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


Changed on 10/14/2018

VAERS ID: 105296 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1997-10-21
Onset:1997-11-01
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / UNK LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-21
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC 'Split Type':

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=105296&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166