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This is VAERS ID 36454

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36454
VAERS Form:
Age:60.0
Sex:Male
Location:West Virginia
Vaccinated:1991-10-01
Onset:1991-10-01
Submitted:1991-11-11
Entered:1991-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 / PARKE-DAVIS 01471P / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: HEMIPLEGIA, MALAISE, ASTHENIA, CREATINE PK INC, MYOPATHY

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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CPK=20,000
CDC 'Split Type':

Write-up: Transient hemiparesis, rhabdomyolysis, myoclobinuria, elevated CPK reported in pt receiving FLuogen; pt exp weakness, fatigue, malaise w/o feve & transient hemiparesis; pt hospitalized w/dx rhabdomyolysis & myoglobinuria;


Changed on 12/8/2009

VAERS ID: 36454 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:West Virginia
Vaccinated:1991-10-01
Onset:1991-10-01
Submitted:1991-11-11
Entered:1991-11-27 1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 INFLUENZA (SEASONAL) (FLUOGEN 91-92) / PARKE-DAVIS 01471P / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Asthenia, Blood creatine phosphokinase increased, Hemiplegia, Malaise, Myopathy, HEMIPLEGIA, MALAISE, ASTHENIA, CREATINE PK INC, MYOPATHY

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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CPK=20,000
CDC 'Split Type': (blank) 914091019

Write-up: Transient hemiparesis, rhabdomyolysis, myoclobinuria, elevated CPK reported in pt receiving FLuogen; pt exp weakness, fatigue, malaise w/o feve & transient hemiparesis; pt hospitalized w/dx rhabdomyolysis & myoglobinuria;


Changed on 8/31/2010

VAERS ID: 36454 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:West Virginia
Vaccinated:1991-10-01
Onset:1991-10-01
Submitted:1991-11-11
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 91-92) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01471P / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Blood creatine phosphokinase increased, Hemiplegia, Malaise, Myopathy

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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CPK=20,000
CDC 'Split Type': 914091019

Write-up: Transient hemiparesis, rhabdomyolysis, myoclobinuria, elevated CPK reported in pt receiving FLuogen; pt exp weakness, fatigue, malaise w/o feve & transient hemiparesis; pt hospitalized w/dx rhabdomyolysis & myoglobinuria;


Changed on 7/7/2013

VAERS ID: 36454 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:West Virginia
Vaccinated:1991-10-01
Onset:1991-10-01
Submitted:1991-11-11
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01471P / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01471P / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Blood creatine phosphokinase increased, Hemiplegia, Malaise, Myopathy

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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CPK=20,000
CDC 'Split Type': 914091019

Write-up: Transient hemiparesis, rhabdomyolysis, myoclobinuria, elevated CPK reported in pt receiving FLuogen; pt exp weakness, fatigue, malaise w/o feve & transient hemiparesis; pt hospitalized w/dx rhabdomyolysis & myoglobinuria;


Changed on 5/14/2017

VAERS ID: 36454 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:West Virginia
Vaccinated:1991-10-01
Onset:1991-10-01
Submitted:1991-11-11
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01471P / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Blood creatine phosphokinase increased, Hemiplegia, Malaise, Myopathy

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: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CPK=20,000
CDC 'Split Type': 914091019

Write-up: Transient hemiparesis, rhabdomyolysis, myoclobinuria, elevated CPK reported in pt receiving FLuogen; pt exp weakness, fatigue, malaise w/o feve & transient hemiparesis; pt hospitalized w/dx rhabdomyolysis & myoglobinuria;


Changed on 9/14/2017

VAERS ID: 36454 Before After
VAERS Form:(blank) 1
Age:60.0
Sex:Male
Location:West Virginia
Vaccinated:1991-10-01
Onset:1991-10-01
Submitted:1991-11-11
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01471P / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Blood creatine phosphokinase increased, Hemiplegia, Malaise, Myopathy

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: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CPK=20,000
CDC 'Split Type': 914091019

Write-up: Transient hemiparesis, rhabdomyolysis, myoclobinuria, elevated CPK reported in pt receiving FLuogen; pt exp weakness, fatigue, malaise w/o feve & transient hemiparesis; pt hospitalized w/dx rhabdomyolysis & myoglobinuria;


Changed on 2/14/2018

VAERS ID: 36454 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:West Virginia
Vaccinated:1991-10-01
Onset:1991-10-01
Submitted:1991-11-11
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01471P / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Blood creatine phosphokinase increased, Hemiplegia, Malaise, Myopathy

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: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CPK=20,000
CDC 'Split Type': 914091019

Write-up: Transient hemiparesis, rhabdomyolysis, myoclobinuria, elevated CPK reported in pt receiving FLuogen; pt exp weakness, fatigue, malaise w/o feve & transient hemiparesis; pt hospitalized w/dx rhabdomyolysis & myoglobinuria;


Changed on 6/14/2018

VAERS ID: 36454 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:West Virginia
Vaccinated:1991-10-01
Onset:1991-10-01
Submitted:1991-11-11
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01471P / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Blood creatine phosphokinase increased, Hemiplegia, Malaise, Myopathy

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: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CPK=20,000
CDC 'Split Type': 914091019

Write-up: Transient hemiparesis, rhabdomyolysis, myoclobinuria, elevated CPK reported in pt receiving FLuogen; pt exp weakness, fatigue, malaise w/o feve & transient hemiparesis; pt hospitalized w/dx rhabdomyolysis & myoglobinuria;


Changed on 8/14/2018

VAERS ID: 36454 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:West Virginia
Vaccinated:1991-10-01
Onset:1991-10-01
Submitted:1991-11-11
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01471P / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Blood creatine phosphokinase increased, Hemiplegia, Malaise, Myopathy

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: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CPK=20,000
CDC 'Split Type': 914091019

Write-up: Transient hemiparesis, rhabdomyolysis, myoclobinuria, elevated CPK reported in pt receiving FLuogen; pt exp weakness, fatigue, malaise w/o feve & transient hemiparesis; pt hospitalized w/dx rhabdomyolysis & myoglobinuria;


Changed on 9/14/2018

VAERS ID: 36454 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:West Virginia
Vaccinated:1991-10-01
Onset:1991-10-01
Submitted:1991-11-11
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01471P / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Blood creatine phosphokinase increased, Hemiplegia, Malaise, Myopathy

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: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CPK=20,000
CDC 'Split Type': 914091019

Write-up: Transient hemiparesis, rhabdomyolysis, myoclobinuria, elevated CPK reported in pt receiving FLuogen; pt exp weakness, fatigue, malaise w/o feve & transient hemiparesis; pt hospitalized w/dx rhabdomyolysis & myoglobinuria;


Changed on 10/14/2018

VAERS ID: 36454 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:West Virginia
Vaccinated:1991-10-01
Onset:1991-10-01
Submitted:1991-11-11
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01471P / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Blood creatine phosphokinase increased, Hemiplegia, Malaise, Myopathy

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: 10     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CPK=20,000
CDC 'Split Type': 914091019

Write-up: Transient hemiparesis, rhabdomyolysis, myoclobinuria, elevated CPK reported in pt receiving FLuogen; pt exp weakness, fatigue, malaise w/o feve & transient hemiparesis; pt hospitalized w/dx rhabdomyolysis & myoglobinuria;

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