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This is VAERS ID 26940

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26940
VAERS Form:
Age:77.7
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1991-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11222 / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: GAIT ABNORM, PAIN, PARESTHESIA, INCONTIN URIN, INCONTIN FECAL

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 12/8/2009

VAERS ID: 26940 Before After
VAERS Form:
Age:77.7
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1991-01-11 1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11222 / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence, GAIT ABNORM, PAIN, PARESTHESIA, INCONTIN URIN, INCONTIN FECAL

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 8/31/2010

VAERS ID: 26940 Before After
VAERS Form:
Age:77.7
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 7/7/2013

VAERS ID: 26940 Before After
VAERS Form:
Age:77.7
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 2/14/2017

VAERS ID: 26940 Before After
VAERS Form:
Age:77.7 77.0
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 5/14/2017

VAERS ID: 26940 Before After
VAERS Form:
Age:77.0
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 9/14/2017

VAERS ID: 26940 Before After
VAERS Form:(blank) 1
Age:77.0
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / - UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 2/14/2018

VAERS ID: 26940 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 6/14/2018

VAERS ID: 26940 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 8/14/2018

VAERS ID: 26940 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 9/14/2018

VAERS ID: 26940 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 10/14/2018

VAERS ID: 26940 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 12/24/2020

VAERS ID: 26940 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.


Changed on 12/30/2020

VAERS ID: 26940 Before After
VAERS Form:1
Age:77.0
Sex:Female
Location:Minnesota
Vaccinated:1990-11-02
Onset:1990-11-03
Submitted:1990-11-30
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11222 / UNK LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Faecal incontinence, Gait disturbance, Pain, Paraesthesia, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: Annual physical
Preexisting Conditions: ASHD COPD
Allergies:
Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy
CDC 'Split Type':

Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=26940&WAYBACKHISTORY=ON


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