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This is VAERS ID 39896

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39896
VAERS Form:
Age:77.0
Sex:Male
Location:Texas
Vaccinated:1990-09-24
Onset:1990-10-06
Submitted:0000-00-00
Entered:1992-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 / PARKE-DAVIS - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: HYPOKINESIA, GUILLAIN BARRE SYND, PARALYSIS, CSF ABNORM, PARAPLEGIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: pt had resection of abdominal aneurysm 4 yrs ago & CABG 6 yrs ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: GBS is reported in a pt who recvd flu vax; 12 days p/inject, pt had sudden paralysis & became paraplegic w/loss of motor & sensory neurological function below the level of T12; pt hospitalized & tx w/meds; MD expect recovery;


Changed on 12/8/2009

VAERS ID: 39896 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Texas
Vaccinated:1990-09-24
Onset:1990-10-06
Submitted:0000-00-00
Entered:1992-03-11 1992-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1991-1992 INFLUENZA (SEASONAL) (FLUOGEN 91-92) / PARKE-DAVIS - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Paralysis, Paraplegia, CSF test abnormal, HYPOKINESIA, GUILLAIN BARRE SYND, PARALYSIS, CSF ABNORM, PARAPLEGIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: pt had resection of abdominal aneurysm 4 yrs ago & CABG 6 yrs ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 904090005

Write-up: GBS is reported in a pt who recvd flu vax; 12 days p/inject, pt had sudden paralysis & became paraplegic w/loss of motor & sensory neurological function below the level of T12; pt hospitalized & tx w/meds; MD expect recovery;


Changed on 8/31/2010

VAERS ID: 39896 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Texas
Vaccinated:1990-09-24
Onset:1990-10-06
Submitted:0000-00-00
Entered:1992-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 91-92) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Paralysis, Paraplegia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: pt had resection of abdominal aneurysm 4 yrs ago & CABG 6 yrs ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090005

Write-up: GBS is reported in a pt who recvd flu vax; 12 days p/inject, pt had sudden paralysis & became paraplegic w/loss of motor & sensory neurological function below the level of T12; pt hospitalized & tx w/meds; MD expect recovery;


Changed on 7/7/2013

VAERS ID: 39896 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Texas
Vaccinated:1990-09-24
Onset:1990-10-06
Submitted:0000-00-00
Entered:1992-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Paralysis, Paraplegia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: pt had resection of abdominal aneurysm 4 yrs ago & CABG 6 yrs ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090005

Write-up: GBS is reported in a pt who recvd flu vax; 12 days p/inject, pt had sudden paralysis & became paraplegic w/loss of motor & sensory neurological function below the level of T12; pt hospitalized & tx w/meds; MD expect recovery;


Changed on 5/14/2017

VAERS ID: 39896 Before After
VAERS Form:
Age:77.0
Sex:Male
Location:Texas
Vaccinated:1990-09-24
Onset:1990-10-06
Submitted:0000-00-00
Entered:1992-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Paralysis, Paraplegia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt had resection of abdominal aneurysm 4 yrs ago & CABG 6 yrs ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090005

Write-up: GBS is reported in a pt who recvd flu vax; 12 days p/inject, pt had sudden paralysis & became paraplegic w/loss of motor & sensory neurological function below the level of T12; pt hospitalized & tx w/meds; MD expect recovery;


Changed on 9/14/2017

VAERS ID: 39896 Before After
VAERS Form:(blank) 1
Age:77.0
Sex:Male
Location:Texas
Vaccinated:1990-09-24
Onset:1990-10-06
Submitted:0000-00-00
Entered:1992-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Paralysis, Paraplegia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt had resection of abdominal aneurysm 4 yrs ago & CABG 6 yrs ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090005

Write-up: GBS is reported in a pt who recvd flu vax; 12 days p/inject, pt had sudden paralysis & became paraplegic w/loss of motor & sensory neurological function below the level of T12; pt hospitalized & tx w/meds; MD expect recovery;


Changed on 2/14/2018

VAERS ID: 39896 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Texas
Vaccinated:1990-09-24
Onset:1990-10-06
Submitted:0000-00-00
Entered:1992-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Paralysis, Paraplegia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt had resection of abdominal aneurysm 4 yrs ago & CABG 6 yrs ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090005

Write-up: GBS is reported in a pt who recvd flu vax; 12 days p/inject, pt had sudden paralysis & became paraplegic w/loss of motor & sensory neurological function below the level of T12; pt hospitalized & tx w/meds; MD expect recovery;


Changed on 6/14/2018

VAERS ID: 39896 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Texas
Vaccinated:1990-09-24
Onset:1990-10-06
Submitted:0000-00-00
Entered:1992-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Paralysis, Paraplegia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt had resection of abdominal aneurysm 4 yrs ago & CABG 6 yrs ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090005

Write-up: GBS is reported in a pt who recvd flu vax; 12 days p/inject, pt had sudden paralysis & became paraplegic w/loss of motor & sensory neurological function below the level of T12; pt hospitalized & tx w/meds; MD expect recovery;


Changed on 8/14/2018

VAERS ID: 39896 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Texas
Vaccinated:1990-09-24
Onset:1990-10-06
Submitted:0000-00-00
Entered:1992-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Paralysis, Paraplegia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt had resection of abdominal aneurysm 4 yrs ago & CABG 6 yrs ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090005

Write-up: GBS is reported in a pt who recvd flu vax; 12 days p/inject, pt had sudden paralysis & became paraplegic w/loss of motor & sensory neurological function below the level of T12; pt hospitalized & tx w/meds; MD expect recovery;


Changed on 9/14/2018

VAERS ID: 39896 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Texas
Vaccinated:1990-09-24
Onset:1990-10-06
Submitted:0000-00-00
Entered:1992-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Paralysis, Paraplegia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt had resection of abdominal aneurysm 4 yrs ago & CABG 6 yrs ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090005

Write-up: GBS is reported in a pt who recvd flu vax; 12 days p/inject, pt had sudden paralysis & became paraplegic w/loss of motor & sensory neurological function below the level of T12; pt hospitalized & tx w/meds; MD expect recovery;


Changed on 10/14/2018

VAERS ID: 39896 Before After
VAERS Form:1
Age:77.0
Sex:Male
Location:Texas
Vaccinated:1990-09-24
Onset:1990-10-06
Submitted:0000-00-00
Entered:1992-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Hypokinesia, Paralysis, Paraplegia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: pt had resection of abdominal aneurysm 4 yrs ago & CABG 6 yrs ago;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 904090005

Write-up: GBS is reported in a pt who recvd flu vax; 12 days p/inject, pt had sudden paralysis & became paraplegic w/loss of motor & sensory neurological function below the level of T12; pt hospitalized & tx w/meds; MD expect recovery;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=39896&WAYBACKHISTORY=ON


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