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This is VAERS ID 36126

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36126
VAERS Form:
Age:2.4
Sex:Male
Location:North Carolina
Vaccinated:1991-10-04
Onset:1991-10-04
Submitted:1991-10-23
Entered:1991-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1991-1992 / CONNAUGHT LABS 1F21209 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, FEVER, EYES GAZE UPWARD, HYPERTONIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NA
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC 'Split Type': NONE

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;


Changed on 12/8/2009

VAERS ID: 36126 Before After
VAERS Form:
Age:2.4
Sex:Male
Location:North Carolina
Vaccinated:1991-10-04
Onset:1991-10-04
Submitted:1991-10-23
Entered:1991-11-07 1991-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1991-1992 INFLUENZA (SEASONAL) (FLUZONE 91-92) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1F21209 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Pyrexia, Gaze palsy, CONVULS, FEVER, EYES GAZE UPWARD, HYPERTONIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NA
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC 'Split Type': NONE NC91085

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;


Changed on 8/31/2010

VAERS ID: 36126 Before After
VAERS Form:
Age:2.4
Sex:Male
Location:North Carolina
Vaccinated:1991-10-04
Onset:1991-10-04
Submitted:1991-10-23
Entered:1991-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 91-92) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Pyrexia, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NA
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC 'Split Type': NC91085

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;


Changed on 7/7/2013

VAERS ID: 36126 Before After
VAERS Form:
Age:2.4
Sex:Male
Location:North Carolina
Vaccinated:1991-10-04
Onset:1991-10-04
Submitted:1991-10-23
Entered:1991-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 0 LL / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Pyrexia, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NA
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC 'Split Type': NC91085

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;


Changed on 2/14/2017

VAERS ID: 36126 Before After
VAERS Form:
Age:2.4 2.0
Sex:Male
Location:North Carolina
Vaccinated:1991-10-04
Onset:1991-10-04
Submitted:1991-10-23
Entered:1991-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Pyrexia, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NA
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC 'Split Type': NC91085

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;


Changed on 5/14/2017

VAERS ID: 36126 Before After
VAERS Form:
Age:2.0
Sex:Male
Location:North Carolina
Vaccinated:1991-10-04
Onset:1991-10-04
Submitted:1991-10-23
Entered:1991-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Pyrexia, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NA NA~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC 'Split Type': NC91085

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;


Changed on 9/14/2017

VAERS ID: 36126 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Male
Location:North Carolina
Vaccinated:1991-10-04
Onset:1991-10-04
Submitted:1991-10-23
Entered:1991-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 0 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Pyrexia, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NA~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC 'Split Type': NC91085

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;


Changed on 2/14/2018

VAERS ID: 36126 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:North Carolina
Vaccinated:1991-10-04
Onset:1991-10-04
Submitted:1991-10-23
Entered:1991-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Pyrexia, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NA~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC 'Split Type': NC91085

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;


Changed on 6/14/2018

VAERS ID: 36126 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:North Carolina
Vaccinated:1991-10-04
Onset:1991-10-04
Submitted:1991-10-23
Entered:1991-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Pyrexia, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NA~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC 'Split Type': NC91085

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;


Changed on 8/14/2018

VAERS ID: 36126 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:North Carolina
Vaccinated:1991-10-04
Onset:1991-10-04
Submitted:1991-10-23
Entered:1991-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Pyrexia, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NA~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC 'Split Type': NC91085

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;


Changed on 9/14/2018

VAERS ID: 36126 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:North Carolina
Vaccinated:1991-10-04
Onset:1991-10-04
Submitted:1991-10-23
Entered:1991-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Pyrexia, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NA~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC 'Split Type': NC91085

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;


Changed on 10/14/2018

VAERS ID: 36126 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:North Carolina
Vaccinated:1991-10-04
Onset:1991-10-04
Submitted:1991-10-23
Entered:1991-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Hypertonia, Pyrexia, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NA~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC/UA/EEG;
CDC 'Split Type': NC91085

Write-up: Sudden onset fever 103.5 seizure activity, eyes rolled back, generalized stiffness;

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