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This is VAERS ID 406908

History of Changes from the VAERS Wayback Machine

First Appeared on 12/7/2010

VAERS ID: 406908
VAERS Form:
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR UT3621GA / - UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / - UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 4/13/2011

VAERS ID: 406908 Before After
VAERS Form:
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR UT3621GA / - UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / - UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Acute respiratory failure, Anaemia, Areflexia, Blood creatine phosphokinase increased, Blood sodium decreased, Blood urea increased, C-reactive protein increased, Chest X-ray, CSF culture negative, CSF protein normal, Death, Duodenal ulcer, Dysaesthesia, Full blood count, Gastrointestinal haemorrhage, Guillain-Barre syndrome, Hypoaesthesia, Intensive care, Lumbar puncture, Multi-organ failure, Muscular weakness, Neutrophil count increased, Pain in extremity, Paraesthesia, Peritonitis, Renal failure acute, Sepsis, Surgery, White blood cell count increased, Red blood cell sedimentation rate increased, CSF glucose increased, Metabolic function test, Transfusion, Mechanical ventilation, Immunoglobulin therapy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 5/13/2011

VAERS ID: 406908 Before After
VAERS Form:
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR UT3621GA / - UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / - UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Acute respiratory failure, Anaemia, Areflexia, Blood creatine phosphokinase increased, Blood sodium decreased, Blood urea increased, C-reactive protein increased, Chest X-ray, CSF culture negative, CSF protein normal, Death, Duodenal ulcer, Dysaesthesia, Full blood count, Gastrointestinal haemorrhage, Guillain-Barre syndrome, Hypoaesthesia, Intensive care, Lumbar puncture, Multi-organ failure, Muscular weakness, Neutrophil count increased, Pain in extremity, Paraesthesia, Peritonitis, Renal failure acute, Sepsis, Surgery, White blood cell count increased, Red blood cell sedimentation rate increased, CSF glucose increased, Metabolic function test, Transfusion, Mechanical ventilation, Immunoglobulin therapy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 7/12/2011

VAERS ID: 406908 Before After
VAERS Form:
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / - UN / IM
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR UT3621GA / - UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / - UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 7/7/2013

VAERS ID: 406908 Before After
VAERS Form:
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / - UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / - UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / - UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 6/14/2014

VAERS ID: 406908 Before After
VAERS Form:
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / - UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / - UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 4/14/2017

VAERS ID: 406908 Before After
VAERS Form:
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / - UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / - UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 9/14/2017

VAERS ID: 406908 Before After
VAERS Form:(blank) 1
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / - UNK UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / - UNK UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 2/14/2018

VAERS ID: 406908 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / UNK UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / UNK UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 6/14/2018

VAERS ID: 406908 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / UNK UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / UNK UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 8/14/2018

VAERS ID: 406908 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / UNK UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / UNK UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 9/14/2018

VAERS ID: 406908 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / UNK UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / UNK UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 10/14/2018

VAERS ID: 406908 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / UNK UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / UNK UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 12/24/2020

VAERS ID: 406908 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / UNK UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / UNK UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 12/30/2020

VAERS ID: 406908 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / UNK UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / UNK UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 5/7/2021

VAERS ID: 406908 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / UNK UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / UNK UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.


Changed on 5/14/2021

VAERS ID: 406908 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:California
Vaccinated:2010-10-22
Onset:2010-10-24
Submitted:2010-11-03
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3621GA / UNK UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0632Y / UNK UN / IM

Administered by: Other      Purchased by: Private
Symptoms: Blood creatine phosphokinase increased, Blood urea increased, Chest X-ray, Dysaesthesia, Full blood count, Hypoaesthesia, Muscular weakness, Pain in extremity, Paraesthesia, White blood cell count increased, Red blood cell sedimentation rate increased, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-09
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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ; Atenolol; Lisinopril; Zolpidem; Simvastatin; Nortriptyline
Current Illness: None
Preexisting Conditions: PCN -allergy; HTN; Diabetes
Allergies:
Diagnostic Lab Data: 10/31/10 CXR done CBC; WBC 14.0; CMP with CK of 263; BUN -29; Sed Rate 53; Transferred to hospital - higher level of care with dx of R/o Guillian Barre Syndrome
CDC 'Split Type':

Write-up: Numbness, pain bilateral lower extremities progressive weakness, tingling, dyesthesias in soles of feet - started on 10/24 seen at clinic on 10/26 - started on LYRICA d/t hx of diabetes seen in ER on 10/31 - with dyesthesias in hands and fingers - transferred to different hospital.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=406908&WAYBACKHISTORY=ON


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