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This is VAERS ID 35526

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 35526
VAERS Form:
Age:55.8
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908194 / - - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': NONE

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


Changed on 12/8/2009

VAERS ID: 35526 Before After
VAERS Form:
Age:55.8
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-22 1991-10-16
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 4908194 / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypertension, Paraesthesia, GUILLAIN BARRE SYND, ASTHENIA, PARESTHESIA, HYPERTENS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': NONE 890354001B

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


Changed on 8/31/2010

VAERS ID: 35526 Before After
VAERS Form:
Age:55.8
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908194 / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypertension, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': 890354001B

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


Changed on 7/7/2013

VAERS ID: 35526 Before After
VAERS Form:
Age:55.8
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypertension, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': 890354001B

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


Changed on 12/14/2016

VAERS ID: 35526 Before After
VAERS Form:
Age:55.8
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypertension, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': 890354001B

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


Changed on 2/14/2017

VAERS ID: 35526 Before After
VAERS Form:
Age:55.8 55.0
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypertension, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': 890354001B

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


Changed on 5/14/2017

VAERS ID: 35526 Before After
VAERS Form:
Age:55.0
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypertension, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': 890354001B

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


Changed on 9/14/2017

VAERS ID: 35526 Before After
VAERS Form:(blank) 1
Age:55.0
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / - UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypertension, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': 890354001B

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


Changed on 2/14/2018

VAERS ID: 35526 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypertension, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': 890354001B

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


Changed on 6/14/2018

VAERS ID: 35526 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypertension, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': 890354001B

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


Changed on 8/14/2018

VAERS ID: 35526 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypertension, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': 890354001B

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


Changed on 9/14/2018

VAERS ID: 35526 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypertension, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': 890354001B

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;


Changed on 10/14/2018

VAERS ID: 35526 Before After
VAERS Form:1
Age:55.0
Sex:Female
Location:Wisconsin
Vaccinated:1990-11-09
Onset:1990-11-24
Submitted:1991-06-07
Entered:1991-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908194 / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Guillain-Barre syndrome, Hypertension, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted;
CDC 'Split Type': 890354001B

Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds;

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