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This is VAERS ID 28416

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28416
VAERS Form:
Age:76.2
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908209 / 2 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND, ASTHENIA

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: 7     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': Coronary-artery disease; had CABG 1986-hx mild emphysema

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 12/8/2009

VAERS ID: 28416 Before After
VAERS Form:
Age:76.2
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-03-05 1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) / WYETH WYETH PHARMACEUTICALS, INC 4908209 / 2 LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Asthenia, Guillain-Barre syndrome, GUILLAIN BARRE SYND, ASTHENIA

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: 7     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': Coronary-artery disease; had CABG 1986-hx mild emphysema GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 8/31/2010

VAERS ID: 28416 Before After
VAERS Form:
Age:76.2
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908209 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 7/7/2013

VAERS ID: 28416 Before After
VAERS Form:
Age:76.2
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 12/14/2016

VAERS ID: 28416 Before After
VAERS Form:
Age:76.2
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 2/14/2017

VAERS ID: 28416 Before After
VAERS Form:
Age:76.2 76.0
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 5/14/2017

VAERS ID: 28416 Before After
VAERS Form:
Age:76.0
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none none~ ()~~~In patient
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 9/14/2017

VAERS ID: 28416 Before After
VAERS Form:(blank) 1
Age:76.0
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 2/14/2018

VAERS ID: 28416 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 6/14/2018

VAERS ID: 28416 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 8/14/2018

VAERS ID: 28416 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 9/14/2018

VAERS ID: 28416 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 10/14/2018

VAERS ID: 28416 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 12/24/2020

VAERS ID: 28416 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

Changed on 12/30/2020

VAERS ID: 28416 Before After
VAERS Form:1
Age:76.0
Sex:Male
Location:Georgia
Vaccinated:1991-01-02
Onset:1991-01-28
Submitted:1991-01-28
Entered:1991-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, 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: 7     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC 'Split Type': GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease

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