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This is VAERS ID 26721

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26721
VAERS Form:
Age:71.9
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908187 / 0 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND, GAIT ABNORM, PARESTHESIA, HYPERTENS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


Changed on 12/8/2009

VAERS ID: 26721 Before After
VAERS Form:
Age:71.9
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-27 1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) / WYETH WYETH PHARMACEUTICALS, INC 4908187 / 0 - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia, GUILLAIN BARRE SYND, GAIT ABNORM, PARESTHESIA, HYPERTENS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


Changed on 8/31/2010

VAERS ID: 26721 Before After
VAERS Form:
Age:71.9
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908187 / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


Changed on 7/7/2013

VAERS ID: 26721 Before After
VAERS Form:
Age:71.9
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 0 - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


Changed on 12/14/2016

VAERS ID: 26721 Before After
VAERS Form:
Age:71.9
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 0 - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


Changed on 2/14/2017

VAERS ID: 26721 Before After
VAERS Form:
Age:71.9 71.0
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


Changed on 5/14/2017

VAERS ID: 26721 Before After
VAERS Form:
Age:71.0
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


Changed on 9/14/2017

VAERS ID: 26721 Before After
VAERS Form:(blank) 1
Age:71.0
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 0 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


Changed on 2/14/2018

VAERS ID: 26721 Before After
VAERS Form:1
Age:71.0
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


Changed on 6/14/2018

VAERS ID: 26721 Before After
VAERS Form:1
Age:71.0
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


Changed on 8/14/2018

VAERS ID: 26721 Before After
VAERS Form:1
Age:71.0
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


Changed on 9/14/2018

VAERS ID: 26721 Before After
VAERS Form:1
Age:71.0
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.


Changed on 10/14/2018

VAERS ID: 26721 Before After
VAERS Form:1
Age:71.0
Sex:Male
Location:Iowa
Vaccinated:1990-10-24
Onset:1990-11-02
Submitted:1990-11-14
Entered:1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908187 / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Gait disturbance, Guillain-Barre syndrome, Hypertension, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Referred to McKennon Hosp for neurology evaluation.
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed funny feeling in both lower extremities, clumsy with both legs which feel numb and tingly. BP 180/100. Rest of exam negative. Lungs are clear. Reflexes diminished. IMP: possible GBS.

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