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This is VAERS ID 28340

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28340
VAERS Form:
Age:58.1
Sex:Male
Location:North Carolina
Vaccinated:1990-11-09
Onset:1990-11-20
Submitted:1991-02-14
Entered:1991-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS PD02680P / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: PAIN BACK, GUILLAIN BARRE SYND, ASTHENIA, PARALYSIS

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC 'Split Type':

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91


Changed on 12/8/2009

VAERS ID: 28340 Before After
VAERS Form:
Age:58.1
Sex:Male
Location:North Carolina
Vaccinated:1990-11-09
Onset:1990-11-20
Submitted:1991-02-14
Entered:1991-02-26 1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS PD02680P / - LA / IM

Administered by: Other      Purchased by: Unknown Public
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paralysis, PAIN BACK, GUILLAIN BARRE SYND, ASTHENIA, PARALYSIS

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC 'Split Type':

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91


Changed on 8/31/2010

VAERS ID: 28340 Before After
VAERS Form:
Age:58.1
Sex:Male
Location:North Carolina
Vaccinated:1990-11-09
Onset:1990-11-20
Submitted:1991-02-14
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02680P / - LA / IM

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

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC 'Split Type':

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91


Changed on 7/7/2013

VAERS ID: 28340 Before After
VAERS Form:
Age:58.1
Sex:Male
Location:North Carolina
Vaccinated:1990-11-09
Onset:1990-11-20
Submitted:1991-02-14
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02680P / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02680P / - LA / IM

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

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC 'Split Type':

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91


Changed on 2/14/2017

VAERS ID: 28340 Before After
VAERS Form:
Age:58.1 58.0
Sex:Male
Location:North Carolina
Vaccinated:1990-11-09
Onset:1990-11-20
Submitted:1991-02-14
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02680P / - LA / IM

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

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC 'Split Type':

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91


Changed on 5/14/2017

VAERS ID: 28340 Before After
VAERS Form:
Age:58.0
Sex:Male
Location:North Carolina
Vaccinated:1990-11-09
Onset:1990-11-20
Submitted:1991-02-14
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02680P / - LA / IM

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

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC 'Split Type':

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91


Changed on 9/14/2017

VAERS ID: 28340 Before After
VAERS Form:(blank) 1
Age:58.0
Sex:Male
Location:North Carolina
Vaccinated:1990-11-09
Onset:1990-11-20
Submitted:1991-02-14
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02680P / - UNK LA / IM

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

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC 'Split Type':

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91


Changed on 2/14/2018

VAERS ID: 28340 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:North Carolina
Vaccinated:1990-11-09
Onset:1990-11-20
Submitted:1991-02-14
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02680P / UNK LA / IM

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

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC 'Split Type':

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91


Changed on 6/14/2018

VAERS ID: 28340 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:North Carolina
Vaccinated:1990-11-09
Onset:1990-11-20
Submitted:1991-02-14
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02680P / UNK LA / IM

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

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC 'Split Type':

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91


Changed on 8/14/2018

VAERS ID: 28340 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:North Carolina
Vaccinated:1990-11-09
Onset:1990-11-20
Submitted:1991-02-14
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02680P / UNK LA / IM

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

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC 'Split Type':

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91


Changed on 9/14/2018

VAERS ID: 28340 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:North Carolina
Vaccinated:1990-11-09
Onset:1990-11-20
Submitted:1991-02-14
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02680P / UNK LA / IM

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

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC 'Split Type':

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91


Changed on 10/14/2018

VAERS ID: 28340 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:North Carolina
Vaccinated:1990-11-09
Onset:1990-11-20
Submitted:1991-02-14
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS PD02680P / UNK LA / IM

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

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC 'Split Type':

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91

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