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This is VAERS ID 27095

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27095
VAERS Form:
Age:64.4
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908208 / - LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND, ASTHENIA

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


Changed on 12/8/2009

VAERS ID: 27095 Before After
VAERS Form:
Age:64.4
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1991-01-10 1990-12-18
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 4908208 / - LA / IM

Administered by: Public      Purchased by: Unknown Other
Symptoms: Asthenia, Guillain-Barre syndrome, GUILLAIN BARRE SYND, ASTHENIA

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


Changed on 8/31/2010

VAERS ID: 27095 Before After
VAERS Form:
Age:64.4
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908208 / - LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


Changed on 7/7/2013

VAERS ID: 27095 Before After
VAERS Form:
Age:64.4
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


Changed on 12/14/2016

VAERS ID: 27095 Before After
VAERS Form:
Age:64.4
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


Changed on 2/14/2017

VAERS ID: 27095 Before After
VAERS Form:
Age:64.4 64.0
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


Changed on 5/14/2017

VAERS ID: 27095 Before After
VAERS Form:
Age:64.0
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


Changed on 9/14/2017

VAERS ID: 27095 Before After
VAERS Form:(blank) 1
Age:64.0
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / - UNK LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


Changed on 2/14/2018

VAERS ID: 27095 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / UNK LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


Changed on 6/14/2018

VAERS ID: 27095 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / UNK LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


Changed on 8/14/2018

VAERS ID: 27095 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / UNK LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


Changed on 9/14/2018

VAERS ID: 27095 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / UNK LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR


Changed on 10/14/2018

VAERS ID: 27095 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:Oregon
Vaccinated:1990-11-02
Onset:1990-12-10
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908208 / UNK LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
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: Ventolin, Synthroid, Mevacor
Current Illness: sick about 1 wk prior to onset of GBS
Preexisting Conditions: Hypothyroid, Asthma, Hyperlipidemia
Allergies:
Diagnostic Lab Data: nerve conduction studies slowing /w evidence of conduction block, CSF protein normal
CDC 'Split Type':

Write-up: Guillain Barre Synd-progressive quadriparesis onset of weakness on 10Dec90, had febrile illness 1 wk prior this /w nausea & diarrhea treated /w Augmentin for a lt lower lobe infiltrate on CXR

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