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This is VAERS ID 473170

History of Changes from the VAERS Wayback Machine

First Appeared on 11/13/2012

VAERS ID: 473170
VAERS Form:
Age:74.0
Sex:Female
Location:Hawaii
Vaccinated:2012-08-01
Onset:2012-08-01
Submitted:0000-00-00
Entered:2012-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis, Demyelination, Myelitis transverse, Nuclear magnetic resonance imaging brain abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-10
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI consistent of ADEM.
CDC 'Split Type': HI1205

Write-up: Transverse myelitis. Region of demyelination in right frontal lobe.


Changed on 7/7/2013

VAERS ID: 473170 Before After
VAERS Form:
Age:74.0
Sex:Female
Location:Hawaii
Vaccinated:2012-08-01
Onset:2012-08-01
Submitted:0000-00-00
Entered:2012-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis, Demyelination, Myelitis transverse, Nuclear magnetic resonance imaging brain abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-10
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI consistent of ADEM.
CDC 'Split Type': HI1205

Write-up: Transverse myelitis. Region of demyelination in right frontal lobe.


Changed on 12/14/2016

VAERS ID: 473170 Before After
VAERS Form:
Age:74.0
Sex:Female
Location:Hawaii
Vaccinated:2012-08-01
Onset:2012-08-01
Submitted:0000-00-00
Entered:2012-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis, Demyelination, Myelitis transverse, Nuclear magnetic resonance imaging brain abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-10
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI consistent of ADEM.
CDC 'Split Type': HI1205

Write-up: Transverse myelitis. Region of demyelination in right frontal lobe.


Changed on 9/14/2017

VAERS ID: 473170 Before After
VAERS Form:(blank) 1
Age:74.0
Sex:Female
Location:Hawaii
Vaccinated:2012-08-01
Onset:2012-08-01
Submitted:0000-00-00
Entered:2012-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis, Demyelination, Myelitis transverse, Nuclear magnetic resonance imaging brain abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-10
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI consistent of ADEM.
CDC 'Split Type': HI1205

Write-up: Transverse myelitis. Region of demyelination in right frontal lobe.


Changed on 2/14/2018

VAERS ID: 473170 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:Hawaii
Vaccinated:2012-08-01
Onset:2012-08-01
Submitted:0000-00-00
Entered:2012-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis, Demyelination, Myelitis transverse, Nuclear magnetic resonance imaging brain abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-10
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI consistent of ADEM.
CDC 'Split Type': HI1205

Write-up: Transverse myelitis. Region of demyelination in right frontal lobe.


Changed on 6/14/2018

VAERS ID: 473170 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:Hawaii
Vaccinated:2012-08-01
Onset:2012-08-01
Submitted:0000-00-00
Entered:2012-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis, Demyelination, Myelitis transverse, Nuclear magnetic resonance imaging brain abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-10
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI consistent of ADEM.
CDC 'Split Type': HI1205

Write-up: Transverse myelitis. Region of demyelination in right frontal lobe.


Changed on 8/14/2018

VAERS ID: 473170 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:Hawaii
Vaccinated:2012-08-01
Onset:2012-08-01
Submitted:0000-00-00
Entered:2012-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis, Demyelination, Myelitis transverse, Nuclear magnetic resonance imaging brain abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-10
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI consistent of ADEM.
CDC 'Split Type': HI1205

Write-up: Transverse myelitis. Region of demyelination in right frontal lobe.


Changed on 9/14/2018

VAERS ID: 473170 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:Hawaii
Vaccinated:2012-08-01
Onset:2012-08-01
Submitted:0000-00-00
Entered:2012-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis, Demyelination, Myelitis transverse, Nuclear magnetic resonance imaging brain abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-10
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI consistent of ADEM.
CDC 'Split Type': HI1205

Write-up: Transverse myelitis. Region of demyelination in right frontal lobe.


Changed on 10/14/2018

VAERS ID: 473170 Before After
VAERS Form:1
Age:74.0
Sex:Female
Location:Hawaii
Vaccinated:2012-08-01
Onset:2012-08-01
Submitted:0000-00-00
Entered:2012-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute disseminated encephalomyelitis, Demyelination, Myelitis transverse, Nuclear magnetic resonance imaging brain abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-10
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI consistent of ADEM.
CDC 'Split Type': HI1205

Write-up: Transverse myelitis. Region of demyelination in right frontal lobe.

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