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This is VAERS ID 27634

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27634
VAERS Form:
Age:31.7
Sex:Male
Location:Tennessee
Vaccinated:1973-02-01
Onset:1973-03-01
Submitted:1991-01-09
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - - / -

Administered by: Military      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND

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: 180     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist.


Changed on 12/8/2009

VAERS ID: 27634 Before After
VAERS Form:
Age:31.7
Sex:Male
Location:Tennessee
Vaccinated:1973-02-01
Onset:1973-03-01
Submitted:1991-01-09
Entered:1991-02-01 1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Military      Purchased by: Unknown Other
Symptoms: Guillain-Barre syndrome, GUILLAIN BARRE SYND

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: 180     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 910006401

Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist.


Changed on 7/7/2013

VAERS ID: 27634 Before After
VAERS Form:
Age:31.7
Sex:Male
Location:Tennessee
Vaccinated:1973-02-01
Onset:1973-03-01
Submitted:1991-01-09
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Military      Purchased by: Other
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 180     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910006401

Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist.


Changed on 12/14/2016

VAERS ID: 27634 Before After
VAERS Form:
Age:31.7
Sex:Male
Location:Tennessee
Vaccinated:1973-02-01
Onset:1973-03-01
Submitted:1991-01-09
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Military      Purchased by: Other
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 180     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910006401

Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist.


Changed on 2/14/2017

VAERS ID: 27634 Before After
VAERS Form:
Age:31.7 31.0
Sex:Male
Location:Tennessee
Vaccinated:1973-02-01
Onset:1973-03-01
Submitted:1991-01-09
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Military      Purchased by: Other
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 180     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910006401

Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist.


Changed on 5/14/2017

VAERS ID: 27634 Before After
VAERS Form:
Age:31.0
Sex:Male
Location:Tennessee
Vaccinated:1973-02-01
Onset:1973-03-01
Submitted:1991-01-09
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Military      Purchased by: Other
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 180     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910006401

Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist.


Changed on 9/14/2017

VAERS ID: 27634 Before After
VAERS Form:(blank) 1
Age:31.0
Sex:Male
Location:Tennessee
Vaccinated:1973-02-01
Onset:1973-03-01
Submitted:1991-01-09
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 180     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910006401

Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist.


Changed on 2/14/2018

VAERS ID: 27634 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Tennessee
Vaccinated:1973-02-01
Onset:1973-03-01
Submitted:1991-01-09
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 180     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910006401

Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist.


Changed on 6/14/2018

VAERS ID: 27634 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Tennessee
Vaccinated:1973-02-01
Onset:1973-03-01
Submitted:1991-01-09
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 180     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910006401

Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist.


Changed on 8/14/2018

VAERS ID: 27634 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Tennessee
Vaccinated:1973-02-01
Onset:1973-03-01
Submitted:1991-01-09
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 180     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910006401

Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist.


Changed on 9/14/2018

VAERS ID: 27634 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Tennessee
Vaccinated:1973-02-01
Onset:1973-03-01
Submitted:1991-01-09
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 180     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910006401

Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist.


Changed on 10/14/2018

VAERS ID: 27634 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Tennessee
Vaccinated:1973-02-01
Onset:1973-03-01
Submitted:1991-01-09
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 180     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 910006401

Write-up: Consumer''s husband, an army inductee was administered influenza virus vaccine (MFR unknown) during winter 1972-1973. Within 1 mo, pt condition dx as GBS. Hospitalized for 6 months. Pt currently under care of neurologist.

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