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This is VAERS ID 150155

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 150155
VAERS Form:
Age:74.0
Sex:Male
Location:Minnesota
Vaccinated:1999-11-15
Onset:1999-11-20
Submitted:2000-03-08
Entered:2000-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1998-1999 / CONNAUGHT LABS U0163AA / - RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: HEADACHE, HALLUCIN

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died". no other info provided.


Changed on 12/8/2009

VAERS ID: 150155 Before After
VAERS Form:
Age:74.0
Sex:Male
Location:Minnesota
Vaccinated:1999-11-15
Onset:1999-11-20
Submitted:2000-03-08
Entered:2000-04-11 2000-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1998-1999 INFLUENZA (SEASONAL) (FLUZONE 98-99) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0163AA / - RA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Hallucination, Headache, HEADACHE, HALLUCIN

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died". died. no other info provided.


Changed on 8/31/2010

VAERS ID: 150155 Before After
VAERS Form:
Age:74.0
Sex:Male
Location:Minnesota
Vaccinated:1999-11-15
Onset:1999-11-20
Submitted:2000-03-08
Entered:2000-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 98-99) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0163AA / - RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hallucination, Headache

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died. no other info provided.


Changed on 7/7/2013

VAERS ID: 150155 Before After
VAERS Form:
Age:74.0
Sex:Male
Location:Minnesota
Vaccinated:1999-11-15
Onset:1999-11-20
Submitted:2000-03-08
Entered:2000-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0163AA / - RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0163AA / - RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hallucination, Headache

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died. no other info provided.


Changed on 5/14/2017

VAERS ID: 150155 Before After
VAERS Form:
Age:74.0
Sex:Male
Location:Minnesota
Vaccinated:1999-11-15
Onset:1999-11-20
Submitted:2000-03-08
Entered:2000-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0163AA / - RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hallucination, Headache

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? No Yes
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died. no other info provided.


Changed on 9/14/2017

VAERS ID: 150155 Before After
VAERS Form:(blank) 1
Age:74.0
Sex:Male
Location:Minnesota
Vaccinated:1999-11-15
Onset:1999-11-20
Submitted:2000-03-08
Entered:2000-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0163AA / - UNK RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hallucination, Headache

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died. no other info provided.


Changed on 2/14/2018

VAERS ID: 150155 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Minnesota
Vaccinated:1999-11-15
Onset:1999-11-20
Submitted:2000-03-08
Entered:2000-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0163AA / UNK RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hallucination, Headache

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died. no other info provided.


Changed on 6/14/2018

VAERS ID: 150155 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Minnesota
Vaccinated:1999-11-15
Onset:1999-11-20
Submitted:2000-03-08
Entered:2000-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0163AA / UNK RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hallucination, Headache

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died. no other info provided.


Changed on 8/14/2018

VAERS ID: 150155 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Minnesota
Vaccinated:1999-11-15
Onset:1999-11-20
Submitted:2000-03-08
Entered:2000-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0163AA / UNK RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hallucination, Headache

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died. no other info provided.


Changed on 9/14/2018

VAERS ID: 150155 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Minnesota
Vaccinated:1999-11-15
Onset:1999-11-20
Submitted:2000-03-08
Entered:2000-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0163AA / UNK RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hallucination, Headache

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died. no other info provided.


Changed on 10/14/2018

VAERS ID: 150155 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Minnesota
Vaccinated:1999-11-15
Onset:1999-11-20
Submitted:2000-03-08
Entered:2000-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0163AA / UNK RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Hallucination, Headache

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: B12 shot
Current Illness: NONE
Preexisting Conditions: hx of rectal incontinence, abdominal injuries, bilateral hearing loss, dementia, hypertension, degenerative joint disease, anemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe headaches, hallucinations, occasional confusion, short term memory loss, delusions, and paranoia of unclear duration. The pt also experienced loss of control of left foot. The pt experienced bleeding from the rectum (bright red). Annual FU: pt died. no other info provided.

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