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This is VAERS ID 28077

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28077
VAERS Form:
Age:72.4
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0J11164 / - - / -

Administered by: Military      Purchased by: Unknown
Symptoms: PAIN BACK, GUILLAIN BARRE SYND, ASTHENIA, PARESTHESIA

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

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 12/8/2009

VAERS ID: 28077 Before After
VAERS Form:
Age:72.4
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-14 1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0J11164 / - - / -

Administered by: Military      Purchased by: Unknown Other
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia, PAIN BACK, GUILLAIN BARRE SYND, ASTHENIA, PARESTHESIA

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 1/5/2010

VAERS ID: 28077 Before After
VAERS Form:
Age:72.4 72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) / CONNAUGHT LABORATORIES 0J11164 / - - / -

Administered by: Military      Purchased by: Other Unknown
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~ ~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 8/31/2010

VAERS ID: 28077 Before After
VAERS Form:
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 90-91) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / - - / -

Administered by: Military      Purchased by: Unknown
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~ ~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 7/7/2013

VAERS ID: 28077 Before After
VAERS Form:
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / - - / -

Administered by: Military      Purchased by: Unknown
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~ ~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 6/14/2014

VAERS ID: 28077 Before After
VAERS Form:
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / - - / -

Administered by: Military      Purchased by: Unknown
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~ ~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 2/14/2017

VAERS ID: 28077 Before After
VAERS Form:
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / - - / -

Administered by: Military      Purchased by: Unknown
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~ ~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 5/14/2017

VAERS ID: 28077 Before After
VAERS Form:
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / - - / -

Administered by: Military      Purchased by: Unknown Other
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~ ~~In ()~~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 9/14/2017

VAERS ID: 28077 Before After
VAERS Form:(blank) 1
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / - UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 2/14/2018

VAERS ID: 28077 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 6/14/2018

VAERS ID: 28077 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 8/14/2018

VAERS ID: 28077 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 9/14/2018

VAERS ID: 28077 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 10/14/2018

VAERS ID: 28077 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 12/24/2020

VAERS ID: 28077 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

Changed on 12/30/2020

VAERS ID: 28077 Before After
VAERS Form:1
Age:72.0
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-16
Onset:1990-10-31
Submitted:1991-02-07
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / UNK - / -

Administered by: Military      Purchased by: Other
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=28077&WAYBACKHISTORY=ON


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