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This is VAERS ID 33096

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 33096
VAERS Form:
Age:68.7
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908209 / 1 A / IM

Administered by: Other      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND, ASTHENIA, PARESTHESIA, REFLEXES DEC

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: Pt exp weakness & numbness @ 67 y/o w/Influenza;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


Changed on 12/8/2009

VAERS ID: 33096 Before After
VAERS Form:
Age:68.7
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-11-02 1991-10-15
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 / 1 A / IM

Administered by: Other      Purchased by: Unknown Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, Paraesthesia, GUILLAIN BARRE SYND, ASTHENIA, PARESTHESIA, REFLEXES DEC

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: Pt exp weakness & numbness @ 67 y/o w/Influenza;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7; 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


Changed on 8/31/2010

VAERS ID: 33096 Before After
VAERS Form:
Age:68.7
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-10-15
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 / 1 A / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


Changed on 7/7/2013

VAERS ID: 33096 Before After
VAERS Form:
Age:68.7
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 A / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 A / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


Changed on 12/14/2016

VAERS ID: 33096 Before After
VAERS Form:
Age:68.7
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 A / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 A / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


Changed on 2/14/2017

VAERS ID: 33096 Before After
VAERS Form:
Age:68.7 68.0
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 A / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


Changed on 5/14/2017

VAERS ID: 33096 Before After
VAERS Form:
Age:68.0
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 A - / IM IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza; w/Influenza;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


Changed on 9/14/2017

VAERS ID: 33096 Before After
VAERS Form:(blank) 1
Age:68.0
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 1 2 - / IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


Changed on 2/14/2018

VAERS ID: 33096 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 - / IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


Changed on 6/14/2018

VAERS ID: 33096 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 - / IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


Changed on 8/14/2018

VAERS ID: 33096 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 - / IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


Changed on 9/14/2018

VAERS ID: 33096 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 - / IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


Changed on 10/14/2018

VAERS ID: 33096 Before After
VAERS Form:1
Age:68.0
Sex:Male
Location:Georgia
Vaccinated:1990-10-18
Onset:1990-11-12
Submitted:1991-02-21
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 - / IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC 'Split Type': 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;

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