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This is VAERS ID 133914

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 133914
VAERS Form:
Age:49.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - - / IM
MEN: MENOMUNE A/C/Y/W / CONNAUGHT LABS - / - - / SC
MMR: MMR II / MSD - / - - / SC
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT / UNCLASSIFIED - / - - / PO
TD: UNK.TD ADSORBED, ADULTS / UNCLASSIFIED - / 2 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: AGITATION, INFECT, ASTHENIA, DIARRHEA, DEHYDRAT

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis.


Changed on 12/8/2009

VAERS ID: 133914 Before After
VAERS Form:
Age:49.0 36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-16 2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - UN / IM
MEN: MENOMUNE A/C/Y/W MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABS CONNAUGHT LABORATORIES - / - - UN / SC
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. - / - - UN / SC
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT POLIO VIRUS, ORAL (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / PO
TD: UNK.TD ADSORBED, ADULTS TD ADSORBED (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / 2 - UN / IM

Administered by: Other Military      Purchased by: Unknown Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation, AGITATION, INFECT, ASTHENIA, DIARRHEA, DEHYDRAT

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.


Changed on 7/7/2013

VAERS ID: 133914 Before After
VAERS Form:
Age:36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES - / - UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / PO
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 UN / IM

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.


Changed on 12/14/2016

VAERS ID: 133914 Before After
VAERS Form:
Age:36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES - / - UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / PO
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 UN / IM

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.


Changed on 9/14/2017

VAERS ID: 133914 Before After
VAERS Form:(blank) 1
Age:36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES - / - UNK UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UNK UN / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - MO / PO
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 3 UN / IM

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.


Changed on 2/14/2018

VAERS ID: 133914 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES - / UNK UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / IM

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.


Changed on 6/14/2018

VAERS ID: 133914 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES - / UNK UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / IM

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.


Changed on 8/14/2018

VAERS ID: 133914 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES - / UNK UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / IM

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.


Changed on 9/14/2018

VAERS ID: 133914 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES - / UNK UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / IM

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.


Changed on 10/14/2018

VAERS ID: 133914 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES - / UNK UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / IM

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.


Changed on 12/24/2020

VAERS ID: 133914 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES - / UNK UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / IM

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.


Changed on 12/30/2020

VAERS ID: 133914 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES - / UNK UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / IM

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.


Changed on 5/7/2021

VAERS ID: 133914 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES - / UNK UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / IM

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.


Changed on 5/14/2021

VAERS ID: 133914 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Florida
Vaccinated:1987-03-01
Onset:1987-03-12
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES - / UNK UN / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 UN / IM

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anxiety, Asthenia, Colonoscopy, Dehydration, Diarrhoea, Infection, Myalgia, Pain, Pericarditis, Vomiting, Psychiatric evaluation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 40     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: debillitating exhaustion & dehydration & nervousness & muscle pain & weakness.
Preexisting Conditions: agoraphobia, irritable bowel syndrome, myofascial disorder
Allergies:
Diagnostic Lab Data: pyschiatric tests, colonoscopy
CDC 'Split Type':

Write-up: Pain, diarrhea, vomiting, dehydration, panic anxiety attacks, muscle pain, & weakness. Infections in right testicle, ears, gums, & pericarditis. 1987 to current: XANAX, VIOXX, ANTIBIOTICS given.

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