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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 108666 |
VAERS Form: | |
Age: | 50.6 |
Sex: | Male |
Location: | Montana |
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED | - / - | - / - |
Administered by: Public Purchased by: Unknown
Symptoms: HYPOKINESIA, NEUROPATHY, VASCULITIS, PARESTHESIA, PARALYSIS
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? No
Previous Vaccinations: NONE
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type': NONE
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-19 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER | - / - | - / - |
Administered by: Public Purchased by: Unknown Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis, HYPOKINESIA, NEUROPATHY, VASCULITIS, PARESTHESIA, PARALYSIS
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? No
Previous Vaccinations: NONE
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type': NONE (blank)
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - | - / - |
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - | - / - |
Administered by: Public Purchased by: Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis
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? No
Previous Vaccinations: NONE
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type':
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - | - / - |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - | - / - |
Administered by: Public Purchased by: Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis
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? No
Previous Vaccinations: NONE
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type':
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - | - / - |
Administered by: Public Purchased by: Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis
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? No
Previous Vaccinations: NONE
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type':
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - | - / - |
Administered by: Public Purchased by: Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis
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? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type':
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - UNK | - / - |
Administered by: Public Purchased by: Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type':
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Public Purchased by: Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type':
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Public Purchased by: Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type':
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Public Purchased by: Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type':
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Public Purchased by: Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type':
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Public Purchased by: Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type':
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Public Purchased by: Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type':
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Vaccinated: | 1997-10-03 |
Onset: | 1997-10-05 |
Submitted: | 1998-03-14 |
Entered: | 1998-03-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Public Purchased by: Private
Symptoms: Hypokinesia, Neuropathy, Paraesthesia, Paralysis, Vasculitis
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vasotec;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 9MAR98 MRI;
CDC 'Split Type':
Write-up: pt recv vax 3OCT97 & 5OCT97 numbness rt foot;13OCT97 saw MD tested for diabetes negative;14NOV97 rt ankle stopped working;7JAN98 myelogram & CAT dx peripheral neuropathy, perineal palsy;
Link To This Search Result:
https://medalerts.org/vaersdb/findfield.php?IDNUMBER=108666&WAYBACKHISTORY=ON
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