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This is VAERS ID 212547

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 212547
VAERS Form:
Age:39.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2001-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / AVENTIS PASTEUR, U0696BA / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: HYPOKINESIA, GUILLAIN BARRE SYND, PARESTHESIA

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 12/8/2009

VAERS ID: 212547 Before After
VAERS Form:
Age:39.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2001-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR, AVENTIS PASTEUR U0696BA / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance, HYPOKINESIA, GUILLAIN BARRE SYND, PARESTHESIA

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 4/13/2011

VAERS ID: 212547 Before After
VAERS Form:
Age:39.0 37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2001-04-01 2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR SANOFI PASTEUR U0696BA / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 7/7/2013

VAERS ID: 212547 Before After
VAERS Form:
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 6/14/2014

VAERS ID: 212547 Before After
VAERS Form:
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 5/14/2017

VAERS ID: 212547 Before After
VAERS Form:
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 9/14/2017

VAERS ID: 212547 Before After
VAERS Form:(blank) 1
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 2/14/2018

VAERS ID: 212547 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 6/14/2018

VAERS ID: 212547 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 8/14/2018

VAERS ID: 212547 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 9/14/2018

VAERS ID: 212547 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 10/14/2018

VAERS ID: 212547 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 12/24/2020

VAERS ID: 212547 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 12/30/2020

VAERS ID: 212547 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 5/7/2021

VAERS ID: 212547 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.


Changed on 5/21/2021

VAERS ID: 212547 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:New Jersey
Vaccinated:2001-11-07
Onset:2002-04-01
Submitted:2003-11-10
Entered:2003-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U0696BA / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Sensory disturbance

Life Threatening? Yes
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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG decreased in nerve conduction.
CDC 'Split Type':

Write-up: Guillain-Barre syndrome with motor and sensory deficit.

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