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This is VAERS ID 27162

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27162
VAERS Form:
Age:44.7
Sex:Male
Location:Unknown
Vaccinated:1990-11-20
Onset:1990-12-09
Submitted:1990-12-18
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: ENCEPHALITIS

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal Tap increased Lymphs, CT, MRI WNL
CDC 'Split Type':

Write-up: Pt vaccinated developed acute encephalo-myelitis


Changed on 12/8/2009

VAERS ID: 27162 Before After
VAERS Form:
Age:44.7
Sex:Male
Location:Unknown
Vaccinated:1990-11-20
Onset:1990-12-09
Submitted:1990-12-18
Entered:1991-01-02 1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Encephalitis, ENCEPHALITIS

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal Tap increased Lymphs, CT, MRI WNL
CDC 'Split Type':

Write-up: Pt vaccinated developed acute encephalo-myelitis


Changed on 7/7/2013

VAERS ID: 27162 Before After
VAERS Form:
Age:44.7
Sex:Male
Location:Unknown
Vaccinated:1990-11-20
Onset:1990-12-09
Submitted:1990-12-18
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal Tap increased Lymphs, CT, MRI WNL
CDC 'Split Type':

Write-up: Pt vaccinated developed acute encephalo-myelitis


Changed on 12/14/2016

VAERS ID: 27162 Before After
VAERS Form:
Age:44.7
Sex:Male
Location:Unknown
Vaccinated:1990-11-20
Onset:1990-12-09
Submitted:1990-12-18
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal Tap increased Lymphs, CT, MRI WNL
CDC 'Split Type':

Write-up: Pt vaccinated developed acute encephalo-myelitis


Changed on 2/14/2017

VAERS ID: 27162 Before After
VAERS Form:
Age:44.7 44.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-20
Onset:1990-12-09
Submitted:1990-12-18
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal Tap increased Lymphs, CT, MRI WNL
CDC 'Split Type':

Write-up: Pt vaccinated developed acute encephalo-myelitis


Changed on 5/14/2017

VAERS ID: 27162 Before After
VAERS Form:
Age:44.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-20
Onset:1990-12-09
Submitted:1990-12-18
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal Tap increased Lymphs, CT, MRI WNL
CDC 'Split Type':

Write-up: Pt vaccinated developed acute encephalo-myelitis


Changed on 9/14/2017

VAERS ID: 27162 Before After
VAERS Form:(blank) 1
Age:44.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-20
Onset:1990-12-09
Submitted:1990-12-18
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal Tap increased Lymphs, CT, MRI WNL
CDC 'Split Type':

Write-up: Pt vaccinated developed acute encephalo-myelitis


Changed on 2/14/2018

VAERS ID: 27162 Before After
VAERS Form:1
Age:44.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-20
Onset:1990-12-09
Submitted:1990-12-18
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal Tap increased Lymphs, CT, MRI WNL
CDC 'Split Type':

Write-up: Pt vaccinated developed acute encephalo-myelitis


Changed on 6/14/2018

VAERS ID: 27162 Before After
VAERS Form:1
Age:44.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-20
Onset:1990-12-09
Submitted:1990-12-18
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal Tap increased Lymphs, CT, MRI WNL
CDC 'Split Type':

Write-up: Pt vaccinated developed acute encephalo-myelitis


Changed on 8/14/2018

VAERS ID: 27162 Before After
VAERS Form:1
Age:44.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-20
Onset:1990-12-09
Submitted:1990-12-18
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal Tap increased Lymphs, CT, MRI WNL
CDC 'Split Type':

Write-up: Pt vaccinated developed acute encephalo-myelitis


Changed on 9/14/2018

VAERS ID: 27162 Before After
VAERS Form:1
Age:44.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-20
Onset:1990-12-09
Submitted:1990-12-18
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal Tap increased Lymphs, CT, MRI WNL
CDC 'Split Type':

Write-up: Pt vaccinated developed acute encephalo-myelitis


Changed on 10/14/2018

VAERS ID: 27162 Before After
VAERS Form:1
Age:44.0
Sex:Male
Location:Unknown
Vaccinated:1990-11-20
Onset:1990-12-09
Submitted:1990-12-18
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Encephalitis

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal Tap increased Lymphs, CT, MRI WNL
CDC 'Split Type':

Write-up: Pt vaccinated developed acute encephalo-myelitis

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=27162&WAYBACKHISTORY=ON


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