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This is VAERS ID 38114

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 38114
VAERS Form:
Age:67.6
Sex:Female
Location:Ohio
Vaccinated:1991-11-22
Onset:1991-11-30
Submitted:1991-12-06
Entered:1991-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS / PARKE-DAVIS 01481P / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND, CSF ABNORM

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations:
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC 'Split Type':

Write-up: Guillian Barre Synd


Changed on 12/8/2009

VAERS ID: 38114 Before After
VAERS Form:
Age:67.6
Sex:Female
Location:Ohio
Vaccinated:1991-11-22
Onset:1991-11-30
Submitted:1991-12-06
Entered:1991-12-26 1991-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1990-1991 PARKE-DAVIS INFLUENZA (SEASONAL) (FLUOGEN 90-91) / PARKE-DAVIS 01481P / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, CSF test abnormal, GUILLAIN BARRE SYND, CSF ABNORM

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations:
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC 'Split Type':

Write-up: Guillian Barre Synd


Changed on 8/31/2010

VAERS ID: 38114 Before After
VAERS Form:
Age:67.6
Sex:Female
Location:Ohio
Vaccinated:1991-11-22
Onset:1991-11-30
Submitted:1991-12-06
Entered:1991-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 90-91) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations:
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC 'Split Type':

Write-up: Guillian Barre Synd


Changed on 7/7/2013

VAERS ID: 38114 Before After
VAERS Form:
Age:67.6
Sex:Female
Location:Ohio
Vaccinated:1991-11-22
Onset:1991-11-30
Submitted:1991-12-06
Entered:1991-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 0 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations:
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC 'Split Type':

Write-up: Guillian Barre Synd


Changed on 2/14/2017

VAERS ID: 38114 Before After
VAERS Form:
Age:67.6 67.0
Sex:Female
Location:Ohio
Vaccinated:1991-11-22
Onset:1991-11-30
Submitted:1991-12-06
Entered:1991-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations:
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC 'Split Type':

Write-up: Guillian Barre Synd


Changed on 5/14/2017

VAERS ID: 38114 Before After
VAERS Form:
Age:67.0
Sex:Female
Location:Ohio
Vaccinated:1991-11-22
Onset:1991-11-30
Submitted:1991-12-06
Entered:1991-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC 'Split Type':

Write-up: Guillian Barre Synd


Changed on 9/14/2017

VAERS ID: 38114 Before After
VAERS Form:(blank) 1
Age:67.0
Sex:Female
Location:Ohio
Vaccinated:1991-11-22
Onset:1991-11-30
Submitted:1991-12-06
Entered:1991-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 0 1 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC 'Split Type':

Write-up: Guillian Barre Synd


Changed on 2/14/2018

VAERS ID: 38114 Before After
VAERS Form:1
Age:67.0
Sex:Female
Location:Ohio
Vaccinated:1991-11-22
Onset:1991-11-30
Submitted:1991-12-06
Entered:1991-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC 'Split Type':

Write-up: Guillian Barre Synd


Changed on 6/14/2018

VAERS ID: 38114 Before After
VAERS Form:1
Age:67.0
Sex:Female
Location:Ohio
Vaccinated:1991-11-22
Onset:1991-11-30
Submitted:1991-12-06
Entered:1991-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC 'Split Type':

Write-up: Guillian Barre Synd


Changed on 8/14/2018

VAERS ID: 38114 Before After
VAERS Form:1
Age:67.0
Sex:Female
Location:Ohio
Vaccinated:1991-11-22
Onset:1991-11-30
Submitted:1991-12-06
Entered:1991-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC 'Split Type':

Write-up: Guillian Barre Synd


Changed on 9/14/2018

VAERS ID: 38114 Before After
VAERS Form:1
Age:67.0
Sex:Female
Location:Ohio
Vaccinated:1991-11-22
Onset:1991-11-30
Submitted:1991-12-06
Entered:1991-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC 'Split Type':

Write-up: Guillian Barre Synd


Changed on 10/14/2018

VAERS ID: 38114 Before After
VAERS Form:1
Age:67.0
Sex:Female
Location:Ohio
Vaccinated:1991-11-22
Onset:1991-11-30
Submitted:1991-12-06
Entered:1991-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC 'Split Type':

Write-up: Guillian Barre Synd

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