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This is VAERS ID 27097

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27097
VAERS Form:
Age:80.9
Sex:Female
Location:Alabama
Vaccinated:1990-11-16
Onset:1990-11-29
Submitted:1990-12-14
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 01870P / 0 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND, MYALGIA, ASTHENIA

Life Threatening? Yes
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: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC 'Split Type':

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90


Changed on 12/8/2009

VAERS ID: 27097 Before After
VAERS Form:
Age:80.9
Sex:Female
Location:Alabama
Vaccinated:1990-11-16
Onset:1990-11-29
Submitted:1990-12-14
Entered:1991-01-10 1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS 01870P / 0 LA / IM

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

Life Threatening? Yes
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: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC 'Split Type':

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90


Changed on 8/31/2010

VAERS ID: 27097 Before After
VAERS Form:
Age:80.9
Sex:Female
Location:Alabama
Vaccinated:1990-11-16
Onset:1990-11-29
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / 0 LA / IM

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

Life Threatening? Yes
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: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC 'Split Type':

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90


Changed on 7/7/2013

VAERS ID: 27097 Before After
VAERS Form:
Age:80.9
Sex:Female
Location:Alabama
Vaccinated:1990-11-16
Onset:1990-11-29
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / 0 LA / IM

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

Life Threatening? Yes
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: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC 'Split Type':

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90


Changed on 2/14/2017

VAERS ID: 27097 Before After
VAERS Form:
Age:80.9 80.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-16
Onset:1990-11-29
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / 0 LA / IM

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

Life Threatening? Yes
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: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC 'Split Type':

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90


Changed on 5/14/2017

VAERS ID: 27097 Before After
VAERS Form:
Age:80.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-16
Onset:1990-11-29
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / 0 LA / IM

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

Life Threatening? Yes
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: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC 'Split Type':

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90


Changed on 9/14/2017

VAERS ID: 27097 Before After
VAERS Form:(blank) 1
Age:80.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-16
Onset:1990-11-29
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / 0 1 LA / IM

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

Life Threatening? Yes
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: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC 'Split Type':

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90


Changed on 2/14/2018

VAERS ID: 27097 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-16
Onset:1990-11-29
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / 1 LA / IM

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

Life Threatening? Yes
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: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC 'Split Type':

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90


Changed on 6/14/2018

VAERS ID: 27097 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-16
Onset:1990-11-29
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / 1 LA / IM

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

Life Threatening? Yes
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: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC 'Split Type':

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90


Changed on 8/14/2018

VAERS ID: 27097 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-16
Onset:1990-11-29
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / 1 LA / IM

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

Life Threatening? Yes
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: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC 'Split Type':

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90


Changed on 9/14/2018

VAERS ID: 27097 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-16
Onset:1990-11-29
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / 1 LA / IM

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

Life Threatening? Yes
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: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC 'Split Type':

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90


Changed on 10/14/2018

VAERS ID: 27097 Before After
VAERS Form:1
Age:80.0
Sex:Female
Location:Alabama
Vaccinated:1990-11-16
Onset:1990-11-29
Submitted:1990-12-14
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / 1 LA / IM

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

Life Threatening? Yes
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: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC 'Split Type':

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90

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