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This is VAERS ID 107856

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 107856
VAERS Form:
Age:79.7
Sex:Female
Location:Michigan
Vaccinated:1997-10-15
Onset:1997-10-16
Submitted:1998-02-21
Entered:1998-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1996-1997 / CONNAUGHT LABS 7F81816 / - LA / -

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

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: 39     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


Changed on 12/8/2009

VAERS ID: 107856 Before After
VAERS Form:
Age:79.7
Sex:Female
Location:Michigan
Vaccinated:1997-10-15
Onset:1997-10-16
Submitted:1998-02-21
Entered:1998-03-02 1998-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1996-1997 INFLUENZA (SEASONAL) (FLUZONE 96-97) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7F81816 / - LA / -

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

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: 39     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


Changed on 8/31/2010

VAERS ID: 107856 Before After
VAERS Form:
Age:79.7
Sex:Female
Location:Michigan
Vaccinated:1997-10-15
Onset:1997-10-16
Submitted:1998-02-21
Entered:1998-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 96-97) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / - LA / -

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

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: 39     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


Changed on 7/7/2013

VAERS ID: 107856 Before After
VAERS Form:
Age:79.7
Sex:Female
Location:Michigan
Vaccinated:1997-10-15
Onset:1997-10-16
Submitted:1998-02-21
Entered:1998-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / - LA / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / - LA / -

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

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: 39     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


Changed on 2/14/2017

VAERS ID: 107856 Before After
VAERS Form:
Age:79.7 79.0
Sex:Female
Location:Michigan
Vaccinated:1997-10-15
Onset:1997-10-16
Submitted:1998-02-21
Entered:1998-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / - LA / -

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

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: 39     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


Changed on 5/14/2017

VAERS ID: 107856 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Michigan
Vaccinated:1997-10-15
Onset:1997-10-16
Submitted:1998-02-21
Entered:1998-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / - LA / -

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

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: 39     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


Changed on 9/14/2017

VAERS ID: 107856 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Female
Location:Michigan
Vaccinated:1997-10-15
Onset:1997-10-16
Submitted:1998-02-21
Entered:1998-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / - UNK LA / -

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

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: 39     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


Changed on 2/14/2018

VAERS ID: 107856 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Michigan
Vaccinated:1997-10-15
Onset:1997-10-16
Submitted:1998-02-21
Entered:1998-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / UNK LA / -

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

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: 39     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


Changed on 6/14/2018

VAERS ID: 107856 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Michigan
Vaccinated:1997-10-15
Onset:1997-10-16
Submitted:1998-02-21
Entered:1998-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / UNK LA / -

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

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: 39     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


Changed on 8/14/2018

VAERS ID: 107856 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Michigan
Vaccinated:1997-10-15
Onset:1997-10-16
Submitted:1998-02-21
Entered:1998-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / UNK LA / -

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

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: 39     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


Changed on 9/14/2018

VAERS ID: 107856 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Michigan
Vaccinated:1997-10-15
Onset:1997-10-16
Submitted:1998-02-21
Entered:1998-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / UNK LA / -

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

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: 39     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;


Changed on 10/14/2018

VAERS ID: 107856 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Michigan
Vaccinated:1997-10-15
Onset:1997-10-16
Submitted:1998-02-21
Entered:1998-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81816 / UNK LA / -

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

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: 39     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Insulin (Humulin);Dyazide;Cardizem;Xanax;
Current Illness: NONE
Preexisting Conditions: diabetes, chronic lymphocytic leukemia, HTN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: dx w/GBS (principal) secondary: adverse effect viral vaccine;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=107856&WAYBACKHISTORY=ON


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