National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 38763

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 38763
VAERS Form:
Age:65.0
Sex:Male
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1992-01-07
Entered:1992-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 / WYETH 4918137 / - LA / IM
PPV: PNEUMOVAX 23 / MSD 1852S / - RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: GAIT ABNORM, PARALYSIS, ATAXIA, DYSARTHRIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC 'Split Type':

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;


Changed on 12/8/2009

VAERS ID: 38763 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1992-01-07
Entered:1992-01-15 1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1991-1992 INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) / WYETH WYETH PHARMACEUTICALS, INC 4918137 / - LA / IM
PPV: PNEUMOVAX 23 PNEUMO (PNEUMOVAX) / MSD MERCK & CO. INC. 1852S / - RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coordination abnormal, Dysarthria, Gait disturbance, Paralysis, GAIT ABNORM, PARALYSIS, ATAXIA, DYSARTHRIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC 'Split Type':

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;


Changed on 8/31/2010

VAERS ID: 38763 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1992-01-07
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 91-92) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4918137 / - LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1852S / - RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coordination abnormal, Dysarthria, Gait disturbance, Paralysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC 'Split Type':

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;


Changed on 7/7/2013

VAERS ID: 38763 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1992-01-07
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918137 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918137 / - LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1852S / - RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coordination abnormal, Dysarthria, Gait disturbance, Paralysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC 'Split Type':

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;


Changed on 12/14/2016

VAERS ID: 38763 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1992-01-07
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918137 / - LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918137 / - LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1852S / - RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coordination abnormal, Dysarthria, Gait disturbance, Paralysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC 'Split Type':

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;


Changed on 5/14/2017

VAERS ID: 38763 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1992-01-07
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918137 / - LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1852S / - RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coordination abnormal, Dysarthria, Gait disturbance, Paralysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC 'Split Type':

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;


Changed on 9/14/2017

VAERS ID: 38763 Before After
VAERS Form:(blank) 1
Age:65.0
Sex:Male
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1992-01-07
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918137 / - UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1852S / - UNK RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coordination abnormal, Dysarthria, Gait disturbance, Paralysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC 'Split Type':

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;


Changed on 2/14/2018

VAERS ID: 38763 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1992-01-07
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918137 / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1852S / UNK RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coordination abnormal, Dysarthria, Gait disturbance, Paralysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC 'Split Type':

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;


Changed on 6/14/2018

VAERS ID: 38763 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1992-01-07
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918137 / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1852S / UNK RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coordination abnormal, Dysarthria, Gait disturbance, Paralysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC 'Split Type':

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;


Changed on 8/14/2018

VAERS ID: 38763 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1992-01-07
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918137 / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1852S / UNK RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coordination abnormal, Dysarthria, Gait disturbance, Paralysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC 'Split Type':

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;


Changed on 9/14/2018

VAERS ID: 38763 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1992-01-07
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918137 / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1852S / UNK RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coordination abnormal, Dysarthria, Gait disturbance, Paralysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC 'Split Type':

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;


Changed on 10/14/2018

VAERS ID: 38763 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1992-01-07
Entered:1992-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918137 / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1852S / UNK RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coordination abnormal, Dysarthria, Gait disturbance, Paralysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-02
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Complete work-up by oncologist for neoplasm was neg; MRI of head, cysternogram & CSR exam neg;
CDC 'Split Type':

Write-up: 48 hrs following vax pt devel mild gait ataxia; this progressed over the ensuing wks to profound ataxia leading to inability to walk; limb ataxia dev together w/dysarthria which progressed nearly complet bulbar paralysis;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=38763&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166