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This is VAERS ID 35111

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 35111
VAERS Form:
Age:15.9
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: HEADACHE, GUILLAIN BARRE SYND, MYALGIA, GAIT ABNORM, FLU SYND

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type':

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;


Changed on 12/8/2009

VAERS ID: 35111 Before After
VAERS Form:
Age:15.9
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-10-03 1991-09-30
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 - / - - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Headache, Hyporeflexia, Influenza, Myalgia, Myasthenic syndrome, Paraesthesia, HEADACHE, GUILLAIN BARRE SYND, MYALGIA, GAIT ABNORM, FLU SYND

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type': (blank) 890318005B

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;


Changed on 8/31/2010

VAERS ID: 35111 Before After
VAERS Form:
Age:15.9
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Headache, Hyporeflexia, Influenza, Myalgia, Myasthenic syndrome, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type': 890318005B

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;


Changed on 7/7/2013

VAERS ID: 35111 Before After
VAERS Form:
Age:15.9
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Headache, Hyporeflexia, Influenza, Myalgia, Myasthenic syndrome, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type': 890318005B

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;


Changed on 12/14/2016

VAERS ID: 35111 Before After
VAERS Form:
Age:15.9
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Headache, Hyporeflexia, Influenza, Myalgia, Myasthenic syndrome, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type': 890318005B

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;


Changed on 2/14/2017

VAERS ID: 35111 Before After
VAERS Form:
Age:15.9 15.0
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Headache, Hyporeflexia, Influenza, Myalgia, Myasthenic syndrome, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type': 890318005B

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;


Changed on 5/14/2017

VAERS ID: 35111 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Headache, Hyporeflexia, Influenza, Myalgia, Myasthenic syndrome, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type': 890318005B

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;


Changed on 9/14/2017

VAERS ID: 35111 Before After
VAERS Form:(blank) 1
Age:15.0
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Headache, Hyporeflexia, Influenza, Myalgia, Myasthenic syndrome, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type': 890318005B

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;


Changed on 2/14/2018

VAERS ID: 35111 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Headache, Hyporeflexia, Influenza, Myalgia, Myasthenic syndrome, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type': 890318005B

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;


Changed on 6/14/2018

VAERS ID: 35111 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Headache, Hyporeflexia, Influenza, Myalgia, Myasthenic syndrome, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type': 890318005B

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;


Changed on 8/14/2018

VAERS ID: 35111 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Headache, Hyporeflexia, Influenza, Myalgia, Myasthenic syndrome, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type': 890318005B

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;


Changed on 9/14/2018

VAERS ID: 35111 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Headache, Hyporeflexia, Influenza, Myalgia, Myasthenic syndrome, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type': 890318005B

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;


Changed on 10/14/2018

VAERS ID: 35111 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Indiana
Vaccinated:1988-10-31
Onset:1988-11-01
Submitted:1990-11-12
Entered:1991-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Gait disturbance, Guillain-Barre syndrome, Headache, Hyporeflexia, Influenza, Myalgia, Myasthenic syndrome, Paraesthesia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 55     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Cytomegalovirus titer were found to be positive; 15DEC88 Gluscose-86, Protein-122; CMV titer $g=160-pos; 12DEC88 ESR-50; 2JAN89 ESR 33; Motor Nerve conduction Velocities-peroneal motor nerve of 39 w/low amplitude response;
CDC 'Split Type': 890318005B

Write-up: Approx 1wk post vax, pt devel flu-like illness, felt run down, h/a; Seen by MD felt sinus h/a; 11DEC88 admitted to Hosp; sx included muscle weakness, gait disturbances, facial weakness, rt shoulder pain, neck stiffness, sensory loss, GBS;

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