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This is VAERS ID 167584

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 167584
VAERS Form:
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUSHIELD 00-01) / WYETH 4008202 / 1 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: PARESTHESIA, EYE DIS, MOVEMENT DIS

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After pt received the vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble and on the 3rd day his mouth was not working. They bandaged eye up to keep it moist. As of 3/7/0"1, don''t have data available. Have to request medical records.


Changed on 12/30/2006

VAERS ID: 167584 Before After
VAERS Form:
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUSHIELD 00-01) / WYETH 4008202 / 1 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: PARESTHESIA, EYE DIS, MOVEMENT DIS

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After pt received the vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble and on the 3rd day his mouth was not working. They bandaged eye up to keep it moist. As of 3/7/0"1, don''t don''''t have data available. Have to request medical records.


Changed on 12/8/2009

VAERS ID: 167584 Before After
VAERS Form:
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-22 2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUSHIELD 00-01) INFLUENZA (SEASONAL) (FLUSHIELD 00-01) / WYETH WYETH PHARMACEUTICALS, INC 4008202 / 1 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder, PARESTHESIA, EYE DIS, MOVEMENT DIS

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After pt the patient received the his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble and on trouble. On the 3rd third day his mouth was not working. They bandaged the eye up to keep it moist. As of 3/7/0"1, don''''t have data available. Have to request medical records.


Changed on 8/31/2010

VAERS ID: 167584 Before After
VAERS Form:
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 00-01) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4008202 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After the patient received his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble. On the third day his mouth was not working. They bandaged the eye up to keep it moist.


Changed on 7/7/2013

VAERS ID: 167584 Before After
VAERS Form:
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008202 / 1 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008202 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After the patient received his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble. On the third day his mouth was not working. They bandaged the eye up to keep it moist.


Changed on 9/14/2017

VAERS ID: 167584 Before After
VAERS Form:(blank) 1
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008202 / 1 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After the patient received his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble. On the third day his mouth was not working. They bandaged the eye up to keep it moist.


Changed on 2/14/2018

VAERS ID: 167584 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008202 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After the patient received his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble. On the third day his mouth was not working. They bandaged the eye up to keep it moist.


Changed on 6/14/2018

VAERS ID: 167584 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008202 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After the patient received his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble. On the third day his mouth was not working. They bandaged the eye up to keep it moist.


Changed on 8/14/2018

VAERS ID: 167584 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008202 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After the patient received his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble. On the third day his mouth was not working. They bandaged the eye up to keep it moist.


Changed on 9/14/2018

VAERS ID: 167584 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008202 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After the patient received his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble. On the third day his mouth was not working. They bandaged the eye up to keep it moist.


Changed on 10/14/2018

VAERS ID: 167584 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008202 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After the patient received his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble. On the third day his mouth was not working. They bandaged the eye up to keep it moist.


Changed on 12/24/2020

VAERS ID: 167584 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008202 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After the patient received his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble. On the third day his mouth was not working. They bandaged the eye up to keep it moist.


Changed on 12/30/2020

VAERS ID: 167584 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008202 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After the patient received his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble. On the third day his mouth was not working. They bandaged the eye up to keep it moist.


Changed on 5/7/2021

VAERS ID: 167584 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008202 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After the patient received his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble. On the third day his mouth was not working. They bandaged the eye up to keep it moist.


Changed on 5/14/2021

VAERS ID: 167584 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:Utah
Vaccinated:2000-11-24
Onset:2000-11-24
Submitted:2001-03-06
Entered:2001-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4008202 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Eye disorder, Hypoaesthesia, Movement disorder

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After the patient received his vaccine, he said it was like he had went to the dentist, the left side of his face was numb. The next day his eye was giving him trouble. On the third day his mouth was not working. They bandaged the eye up to keep it moist.

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