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This is VAERS ID 36763

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36763
VAERS Form:
Age:54.8
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918146 / - A / IM

Administered by: Other      Purchased by: Unknown
Symptoms: HYPOKINESIA, PAIN, ASTHENIA, PARESTHESIA

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


Changed on 12/8/2009

VAERS ID: 36763 Before After
VAERS Form:
Age:54.8
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-06 1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918146 / - A / IM

Administered by: Other      Purchased by: Unknown Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia, HYPOKINESIA, PAIN, ASTHENIA, PARESTHESIA

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


Changed on 8/31/2010

VAERS ID: 36763 Before After
VAERS Form:
Age:54.8
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918146 / - A / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


Changed on 7/7/2013

VAERS ID: 36763 Before After
VAERS Form:
Age:54.8
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / - A / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / - A / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


Changed on 12/14/2016

VAERS ID: 36763 Before After
VAERS Form:
Age:54.8
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / - A / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / - A / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


Changed on 2/14/2017

VAERS ID: 36763 Before After
VAERS Form:
Age:54.8 54.0
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / - A / IM

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


Changed on 5/14/2017

VAERS ID: 36763 Before After
VAERS Form:
Age:54.0
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / - A - / IM IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


Changed on 9/14/2017

VAERS ID: 36763 Before After
VAERS Form:(blank) 1
Age:54.0
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / - UNK - / IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


Changed on 2/14/2018

VAERS ID: 36763 Before After
VAERS Form:1
Age:54.0
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / UNK - / IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


Changed on 6/14/2018

VAERS ID: 36763 Before After
VAERS Form:1
Age:54.0
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / UNK - / IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


Changed on 8/14/2018

VAERS ID: 36763 Before After
VAERS Form:1
Age:54.0
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / UNK - / IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


Changed on 9/14/2018

VAERS ID: 36763 Before After
VAERS Form:1
Age:54.0
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / UNK - / IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


Changed on 10/14/2018

VAERS ID: 36763 Before After
VAERS Form:1
Age:54.0
Sex:Male
Location:Colorado
Vaccinated:1991-10-30
Onset:1991-11-04
Submitted:1991-11-21
Entered:1991-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / UNK - / IM A

Administered by: Other      Purchased by: Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;

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