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This is VAERS ID 36736

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36736
VAERS Form:
Age:65.6
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 10300080808020 / 0 LA / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: PARALYSIS FACIAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type': chronic renal failure NKA

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


Changed on 12/8/2009

VAERS ID: 36736 Before After
VAERS Form:
Age:65.6
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-05 1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 10300080808020 / 0 LA / -

Administered by: Unknown      Purchased by: Unknown Private
Symptoms: Facial palsy, PARALYSIS FACIAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type': chronic renal failure NKA (blank)

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


Changed on 8/31/2010

VAERS ID: 36736 Before After
VAERS Form:
Age:65.6
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 10300080808020 / 0 LA / -

Administered by: Unknown      Purchased by: Private
Symptoms: Facial palsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type':

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


Changed on 7/7/2013

VAERS ID: 36736 Before After
VAERS Form:
Age:65.6
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 0 LA / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 0 LA / -

Administered by: Unknown      Purchased by: Private
Symptoms: Facial palsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type':

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


Changed on 12/14/2016

VAERS ID: 36736 Before After
VAERS Form:
Age:65.6
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 0 LA / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 0 LA / -

Administered by: Unknown      Purchased by: Private
Symptoms: Facial palsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type':

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


Changed on 2/14/2017

VAERS ID: 36736 Before After
VAERS Form:
Age:65.6 65.0
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 0 LA / -

Administered by: Unknown      Purchased by: Private
Symptoms: Facial palsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type':

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


Changed on 5/14/2017

VAERS ID: 36736 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 0 LA / -

Administered by: Unknown      Purchased by: Private
Symptoms: Facial palsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type':

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


Changed on 9/14/2017

VAERS ID: 36736 Before After
VAERS Form:(blank) 1
Age:65.0
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 0 1 LA / -

Administered by: Unknown      Purchased by: Private
Symptoms: Facial palsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type':

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


Changed on 2/14/2018

VAERS ID: 36736 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 1 LA / -

Administered by: Unknown      Purchased by: Private
Symptoms: Facial palsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type':

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


Changed on 6/14/2018

VAERS ID: 36736 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 1 LA / -

Administered by: Unknown      Purchased by: Private
Symptoms: Facial palsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type':

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


Changed on 8/14/2018

VAERS ID: 36736 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 1 LA / -

Administered by: Unknown      Purchased by: Private
Symptoms: Facial palsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type':

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


Changed on 9/14/2018

VAERS ID: 36736 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 1 LA / -

Administered by: Unknown      Purchased by: Private
Symptoms: Facial palsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type':

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;


Changed on 10/14/2018

VAERS ID: 36736 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1991-11-11
Onset:1991-11-12
Submitted:1991-11-25
Entered:1991-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 10300080808020 / 1 LA / -

Administered by: Unknown      Purchased by: Private
Symptoms: Facial palsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: ESRD
Preexisting Conditions: chronic renal failure NKA
Allergies:
Diagnostic Lab Data: bells palsy
CDC 'Split Type':

Write-up: Pt recvd Influenza A&B vax on 8NOV91 & 12NOV91 aobut 4PM pt devel a droopy mouth on rt side; Pt consulted MD & was referred to neurologist who dx bells palsy;

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=36736&WAYBACKHISTORY=ON


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