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This is VAERS ID 37809

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 37809
VAERS Form:
Age:
Sex:Male
Location:Nevada
Vaccinated:1991-10-07
Onset:1991-10-13
Submitted:1991-12-02
Entered:1991-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1991-1992 / CONNAUGHT LABS 1J21107 / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND, PARESTHESIA

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: assume well @ time of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax;


Changed on 12/8/2009

VAERS ID: 37809 Before After
VAERS Form:
Age:
Sex:Male
Location:Nevada
Vaccinated:1991-10-07
Onset:1991-10-13
Submitted:1991-12-02
Entered:1991-12-12 1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1991-1992 INFLUENZA (SEASONAL) (FLUZONE 91-92) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1J21107 / - - / IM

Administered by: Other      Purchased by: Unknown Public
Symptoms: Guillain-Barre syndrome, Paraesthesia, GUILLAIN BARRE SYND, PARESTHESIA

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: assume well @ time of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CO4030

Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax;


Changed on 8/31/2010

VAERS ID: 37809 Before After
VAERS Form:
Age:
Sex:Male
Location:Nevada
Vaccinated:1991-10-07
Onset:1991-10-13
Submitted:1991-12-02
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 91-92) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1J21107 / - - / IM

Administered by: Other      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: assume well @ time of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4030

Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax;


Changed on 7/7/2013

VAERS ID: 37809 Before After
VAERS Form:
Age:
Sex:Male
Location:Nevada
Vaccinated:1991-10-07
Onset:1991-10-13
Submitted:1991-12-02
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1J21107 / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1J21107 / - - / IM

Administered by: Other      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: assume well @ time of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4030

Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax;


Changed on 5/14/2017

VAERS ID: 37809 Before After
VAERS Form:
Age:
Sex:Male
Location:Nevada
Vaccinated:1991-10-07
Onset:1991-10-13
Submitted:1991-12-02
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1J21107 / - - / IM

Administered by: Other      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: assume well @ time of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4030

Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax;


Changed on 9/14/2017

VAERS ID: 37809 Before After
VAERS Form:(blank) 1
Age:
Sex:Male
Location:Nevada
Vaccinated:1991-10-07
Onset:1991-10-13
Submitted:1991-12-02
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1J21107 / - UNK - / IM

Administered by: Other      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: assume well @ time of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4030

Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax;


Changed on 2/14/2018

VAERS ID: 37809 Before After
VAERS Form:1
Age:
Sex:Male
Location:Nevada
Vaccinated:1991-10-07
Onset:1991-10-13
Submitted:1991-12-02
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1J21107 / UNK - / IM

Administered by: Other      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: assume well @ time of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4030

Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax;


Changed on 6/14/2018

VAERS ID: 37809 Before After
VAERS Form:1
Age:
Sex:Male
Location:Nevada
Vaccinated:1991-10-07
Onset:1991-10-13
Submitted:1991-12-02
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1J21107 / UNK - / IM

Administered by: Other      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: assume well @ time of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4030

Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax;


Changed on 8/14/2018

VAERS ID: 37809 Before After
VAERS Form:1
Age:
Sex:Male
Location:Nevada
Vaccinated:1991-10-07
Onset:1991-10-13
Submitted:1991-12-02
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1J21107 / UNK - / IM

Administered by: Other      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: assume well @ time of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4030

Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax;


Changed on 9/14/2018

VAERS ID: 37809 Before After
VAERS Form:1
Age:
Sex:Male
Location:Nevada
Vaccinated:1991-10-07
Onset:1991-10-13
Submitted:1991-12-02
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1J21107 / UNK - / IM

Administered by: Other      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: assume well @ time of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4030

Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax;


Changed on 10/14/2018

VAERS ID: 37809 Before After
VAERS Form:1
Age:
Sex:Male
Location:Nevada
Vaccinated:1991-10-07
Onset:1991-10-13
Submitted:1991-12-02
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1J21107 / UNK - / IM

Administered by: Other      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paraesthesia

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: assume well @ time of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4030

Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=37809&WAYBACKHISTORY=ON


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