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This is VAERS ID 413868

History of Changes from the VAERS Wayback Machine

First Appeared on 1/4/2011

VAERS ID: 413868
VAERS Form:
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 0 LA / IM
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 0 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 4/13/2011

VAERS ID: 413868 Before After
VAERS Form:
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 0 LA / IM
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 0 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Back pain, Bacteraemia, Colostomy, Constipation, Coronary artery occlusion, CSF protein increased, Death, Electrocardiogram ST segment elevation, Fall, Foreign travel, Gait disturbance, Gastritis erosive, Gastrointestinal haemorrhage, Guillain-Barre syndrome, Hypoaesthesia, Megacolon, Muscular weakness, Myocardial infarction, Pain in extremity, Peroneal nerve palsy, Pneumonia, Pneumothorax, Renal failure acute, Sepsis, Thrombocytopenia, Tracheostomy, Abasia, Chest tube insertion, Facial paresis, Coronary arterial stent insertion, Intra-aortic balloon placement, Gastrointestinal tube insertion, CSF white blood cell count increased, Wound evisceration, Pneumatosis intestinalis, Escherichia infection, Colectomy, Abdominal wound dehiscence, Mechanical ventilation, Immunoglobulin therapy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 5/13/2011

VAERS ID: 413868 Before After
VAERS Form:
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 0 LA / IM
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 0 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Back pain, Bacteraemia, Colostomy, Constipation, Coronary artery occlusion, CSF protein increased, Death, Electrocardiogram ST segment elevation, Fall, Foreign travel, Gait disturbance, Gastritis erosive, Gastrointestinal haemorrhage, Guillain-Barre syndrome, Hypoaesthesia, Megacolon, Muscular weakness, Myocardial infarction, Pain in extremity, Peroneal nerve palsy, Pneumonia, Pneumothorax, Renal failure acute, Sepsis, Thrombocytopenia, Tracheostomy, Abasia, Chest tube insertion, Facial paresis, Coronary arterial stent insertion, Intra-aortic balloon placement, Gastrointestinal tube insertion, CSF white blood cell count increased, Wound evisceration, Pneumatosis intestinalis, Escherichia infection, Colectomy, Abdominal wound dehiscence, Mechanical ventilation, Immunoglobulin therapy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 9/14/2017

VAERS ID: 413868 Before After
VAERS Form:(blank) 1
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 0 1 LA / IM
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 0 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 2/14/2018

VAERS ID: 413868 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 1 LA / IM
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 6/14/2018

VAERS ID: 413868 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 1 LA / IM
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 8/14/2018

VAERS ID: 413868 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 1 LA / IM
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 9/14/2018

VAERS ID: 413868 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 1 LA / IM
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 10/14/2018

VAERS ID: 413868 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 1 LA / IM
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 8/14/2019

VAERS ID: 413868 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 1 LA / IM
VARZOS: ZOSTER (ZOSTAVAX) ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 12/24/2020

VAERS ID: 413868 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 1 LA / IM
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 12/30/2020

VAERS ID: 413868 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 1 LA / IM
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 5/7/2021

VAERS ID: 413868 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 1 LA / IM
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


Changed on 5/14/2021

VAERS ID: 413868 Before After
VAERS Form:1
Age:70.0
Sex:Male
Location:New York
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted:2010-12-28
Entered:2011-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 1 LA / IM
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death, Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-11
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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC 'Split Type':

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=413868&WAYBACKHISTORY=ON

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