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This is VAERS ID 35964

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 35964
VAERS Form:
Age:69.8
Sex:Male
Location:Illinois
Vaccinated:1990-10-08
Onset:1990-10-13
Submitted:1990-10-18
Entered:1991-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: HYPOKINESIA, 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: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid, Humulin-NPH reg Insulin, Nitrodur, Lasix
Current Illness: Insulin dependent diabetic, renal failur
Preexisting Conditions: diabetic dependent on insulin, chronic renal failure, CHF, NKA;
Allergies:
Diagnostic Lab Data: EMG-finding compatable w/diffuse neurogenic process w/inflammatory neuropathy; pt refused sp tap;
CDC 'Split Type':

Write-up: 5 days p/flu shot pt noted weakness of lower extremities progressed to inability to walk & weakness in upper extremities;


Changed on 12/8/2009

VAERS ID: 35964 Before After
VAERS Form:
Age:69.8
Sex:Male
Location:Illinois
Vaccinated:1990-10-08
Onset:1990-10-13
Submitted:1990-10-18
Entered:1991-11-06 1991-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Asthenia, Hypokinesia, HYPOKINESIA, 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: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid, Humulin-NPH reg Insulin, Nitrodur, Lasix
Current Illness: Insulin dependent diabetic, renal failur
Preexisting Conditions: diabetic dependent on insulin, chronic renal failure, CHF, NKA;
Allergies:
Diagnostic Lab Data: EMG-finding compatable w/diffuse neurogenic process w/inflammatory neuropathy; pt refused sp tap;
CDC 'Split Type':

Write-up: 5 days p/flu shot pt noted weakness of lower extremities progressed to inability to walk & weakness in upper extremities;


Changed on 8/31/2010

VAERS ID: 35964 Before After
VAERS Form:
Age:69.8
Sex:Male
Location:Illinois
Vaccinated:1990-10-08
Onset:1990-10-13
Submitted:1990-10-18
Entered:1991-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Hypokinesia

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: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid, Humulin-NPH reg Insulin, Nitrodur, Lasix
Current Illness: Insulin dependent diabetic, renal failur
Preexisting Conditions: diabetic dependent on insulin, chronic renal failure, CHF, NKA;
Allergies:
Diagnostic Lab Data: EMG-finding compatable w/diffuse neurogenic process w/inflammatory neuropathy; pt refused sp tap;
CDC 'Split Type':

Write-up: 5 days p/flu shot pt noted weakness of lower extremities progressed to inability to walk & weakness in upper extremities;


Changed on 7/7/2013

VAERS ID: 35964 Before After
VAERS Form:
Age:69.8
Sex:Male
Location:Illinois
Vaccinated:1990-10-08
Onset:1990-10-13
Submitted:1990-10-18
Entered:1991-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Hypokinesia

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: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid, Humulin-NPH reg Insulin, Nitrodur, Lasix
Current Illness: Insulin dependent diabetic, renal failur
Preexisting Conditions: diabetic dependent on insulin, chronic renal failure, CHF, NKA;
Allergies:
Diagnostic Lab Data: EMG-finding compatable w/diffuse neurogenic process w/inflammatory neuropathy; pt refused sp tap;
CDC 'Split Type':

Write-up: 5 days p/flu shot pt noted weakness of lower extremities progressed to inability to walk & weakness in upper extremities;


Changed on 2/14/2017

VAERS ID: 35964 Before After
VAERS Form:
Age:69.8 69.0
Sex:Male
Location:Illinois
Vaccinated:1990-10-08
Onset:1990-10-13
Submitted:1990-10-18
Entered:1991-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Hypokinesia

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: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid, Humulin-NPH reg Insulin, Nitrodur, Lasix
Current Illness: Insulin dependent diabetic, renal failur
Preexisting Conditions: diabetic dependent on insulin, chronic renal failure, CHF, NKA;
Allergies:
Diagnostic Lab Data: EMG-finding compatable w/diffuse neurogenic process w/inflammatory neuropathy; pt refused sp tap;
CDC 'Split Type':

Write-up: 5 days p/flu shot pt noted weakness of lower extremities progressed to inability to walk & weakness in upper extremities;


Changed on 5/14/2017

VAERS ID: 35964 Before After
VAERS Form:
Age:69.0
Sex:Male
Location:Illinois
Vaccinated:1990-10-08
Onset:1990-10-13
Submitted:1990-10-18
Entered:1991-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Hypokinesia

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: 13     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Synthroid, Humulin-NPH reg Insulin, Nitrodur, Lasix
Current Illness: Insulin dependent diabetic, renal failur
Preexisting Conditions: diabetic dependent on insulin, chronic renal failure, CHF, NKA;
Allergies:
Diagnostic Lab Data: EMG-finding compatable w/diffuse neurogenic process w/inflammatory neuropathy; pt refused sp tap;
CDC 'Split Type':

Write-up: 5 days p/flu shot pt noted weakness of lower extremities progressed to inability to walk & weakness in upper extremities;


Changed on 9/14/2017

VAERS ID: 35964 Before After
VAERS Form:(blank) 1
Age:69.0
Sex:Male
Location:Illinois
Vaccinated:1990-10-08
Onset:1990-10-13
Submitted:1990-10-18
Entered:1991-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Hypokinesia

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: 13     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Synthroid, Humulin-NPH reg Insulin, Nitrodur, Lasix
Current Illness: Insulin dependent diabetic, renal failur
Preexisting Conditions: diabetic dependent on insulin, chronic renal failure, CHF, NKA;
Allergies:
Diagnostic Lab Data: EMG-finding compatable w/diffuse neurogenic process w/inflammatory neuropathy; pt refused sp tap;
CDC 'Split Type':

Write-up: 5 days p/flu shot pt noted weakness of lower extremities progressed to inability to walk & weakness in upper extremities;


Changed on 2/14/2018

VAERS ID: 35964 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Illinois
Vaccinated:1990-10-08
Onset:1990-10-13
Submitted:1990-10-18
Entered:1991-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Hypokinesia

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: 13     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Synthroid, Humulin-NPH reg Insulin, Nitrodur, Lasix
Current Illness: Insulin dependent diabetic, renal failur
Preexisting Conditions: diabetic dependent on insulin, chronic renal failure, CHF, NKA;
Allergies:
Diagnostic Lab Data: EMG-finding compatable w/diffuse neurogenic process w/inflammatory neuropathy; pt refused sp tap;
CDC 'Split Type':

Write-up: 5 days p/flu shot pt noted weakness of lower extremities progressed to inability to walk & weakness in upper extremities;


Changed on 6/14/2018

VAERS ID: 35964 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Illinois
Vaccinated:1990-10-08
Onset:1990-10-13
Submitted:1990-10-18
Entered:1991-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Hypokinesia

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: 13     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Synthroid, Humulin-NPH reg Insulin, Nitrodur, Lasix
Current Illness: Insulin dependent diabetic, renal failur
Preexisting Conditions: diabetic dependent on insulin, chronic renal failure, CHF, NKA;
Allergies:
Diagnostic Lab Data: EMG-finding compatable w/diffuse neurogenic process w/inflammatory neuropathy; pt refused sp tap;
CDC 'Split Type':

Write-up: 5 days p/flu shot pt noted weakness of lower extremities progressed to inability to walk & weakness in upper extremities;


Changed on 8/14/2018

VAERS ID: 35964 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Illinois
Vaccinated:1990-10-08
Onset:1990-10-13
Submitted:1990-10-18
Entered:1991-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Hypokinesia

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: 13     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Synthroid, Humulin-NPH reg Insulin, Nitrodur, Lasix
Current Illness: Insulin dependent diabetic, renal failur
Preexisting Conditions: diabetic dependent on insulin, chronic renal failure, CHF, NKA;
Allergies:
Diagnostic Lab Data: EMG-finding compatable w/diffuse neurogenic process w/inflammatory neuropathy; pt refused sp tap;
CDC 'Split Type':

Write-up: 5 days p/flu shot pt noted weakness of lower extremities progressed to inability to walk & weakness in upper extremities;


Changed on 9/14/2018

VAERS ID: 35964 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Illinois
Vaccinated:1990-10-08
Onset:1990-10-13
Submitted:1990-10-18
Entered:1991-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Hypokinesia

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: 13     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Synthroid, Humulin-NPH reg Insulin, Nitrodur, Lasix
Current Illness: Insulin dependent diabetic, renal failur
Preexisting Conditions: diabetic dependent on insulin, chronic renal failure, CHF, NKA;
Allergies:
Diagnostic Lab Data: EMG-finding compatable w/diffuse neurogenic process w/inflammatory neuropathy; pt refused sp tap;
CDC 'Split Type':

Write-up: 5 days p/flu shot pt noted weakness of lower extremities progressed to inability to walk & weakness in upper extremities;


Changed on 10/14/2018

VAERS ID: 35964 Before After
VAERS Form:1
Age:69.0
Sex:Male
Location:Illinois
Vaccinated:1990-10-08
Onset:1990-10-13
Submitted:1990-10-18
Entered:1991-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Hypokinesia

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: 13     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Synthroid, Humulin-NPH reg Insulin, Nitrodur, Lasix
Current Illness: Insulin dependent diabetic, renal failur
Preexisting Conditions: diabetic dependent on insulin, chronic renal failure, CHF, NKA;
Allergies:
Diagnostic Lab Data: EMG-finding compatable w/diffuse neurogenic process w/inflammatory neuropathy; pt refused sp tap;
CDC 'Split Type':

Write-up: 5 days p/flu shot pt noted weakness of lower extremities progressed to inability to walk & weakness in upper extremities;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=35964&WAYBACKHISTORY=ON


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