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This is VAERS ID 482371

History of Changes from the VAERS Wayback Machine

First Appeared on 2/13/2013

VAERS ID: 482371
VAERS Form:
Age:65.0
Sex:Male
Location:Virginia
Vaccinated:2012-10-24
Onset:0000-00-00
Submitted:2013-01-24
Entered:2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206101W / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Aphasia, Asthenia, Chest pain, Death, Gait disturbance, Guillain-Barre syndrome, Oedema peripheral

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Chronic kidney diseas, hypertension, gout
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA13002

Write-up: Hospitalized 12/12/12 through 12/22/12 at medical center. Complaints of 6 months'' increasing edema in hands and feet, current unsteady gait, decreased strength. Diagnosed with Guillain-Barre Syndrome. Readmit 1/3/13 with worsening weakness, dysphasia. 1/5/13, expired during transport by ambulance. Stopped at community hospital while en route. DOA at community hospital. Medical center reporting seen at another medical center prior to current medical center 1/3/13 admission for chest pain. Ruled out MI at that time.


Changed on 7/7/2013

VAERS ID: 482371 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:Virginia
Vaccinated:2012-10-24
Onset:0000-00-00
Submitted:2013-01-24
Entered:2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206101W / 2 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206101W / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Aphasia, Asthenia, Chest pain, Death, Gait disturbance, Guillain-Barre syndrome, Oedema peripheral

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Chronic kidney diseas, hypertension, gout
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA13002

Write-up: Hospitalized 12/12/12 through 12/22/12 at medical center. Complaints of 6 months'' increasing edema in hands and feet, current unsteady gait, decreased strength. Diagnosed with Guillain-Barre Syndrome. Readmit 1/3/13 with worsening weakness, dysphasia. 1/5/13, expired during transport by ambulance. Stopped at community hospital while en route. DOA at community hospital. Medical center reporting seen at another medical center prior to current medical center 1/3/13 admission for chest pain. Ruled out MI at that time.


Changed on 9/17/2013

VAERS ID: 482371 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:Virginia
Vaccinated:2012-10-24
Onset:0000-00-00
Submitted:2013-01-24
Entered:2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206101W / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Aphasia, Asthenia, Chest pain, Death, Gait disturbance, Guillain-Barre syndrome, Oedema peripheral, Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Chronic kidney diseas, hypertension, gout
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA13002

Write-up: Hospitalized 12/12/12 through 12/22/12 at medical center. Complaints of 6 months'' increasing edema in hands and feet, current unsteady gait, decreased strength. Diagnosed with Guillain-Barre Syndrome. Readmit 1/3/13 with worsening weakness, dysphasia. 1/5/13, expired during transport by ambulance. Stopped at community hospital while en route. DOA at community hospital. Medical center reporting seen at another medical center prior to current medical center 1/3/13 admission for chest pain. Ruled out MI at that time. The following information was obtained through follow-up and/or provided by the government. 05/03/2013 Death Certificate received. Final Cause of Death: Pulmonary Embolus due to/or as a consequence of Guillain Barre.


Changed on 3/14/2015

VAERS ID: 482371 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:Virginia
Vaccinated:2012-10-24
Onset:0000-00-00
Submitted:2013-01-24
Entered:2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206101W / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Aphasia, Asthenia, Chest pain, Death, Gait disturbance, Guillain-Barre syndrome, Oedema peripheral, Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Chronic kidney diseas, hypertension, gout
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA13002

Write-up: Hospitalized 12/12/12 through 12/22/12 at medical center. Complaints of 6 months'' increasing edema in hands and feet, current unsteady gait, decreased strength. Diagnosed with Guillain-Barre Syndrome. Readmit 1/3/13 with worsening weakness, dysphasia. 1/5/13, expired during transport by ambulance. Stopped at community hospital while en route. DOA at community hospital. Medical center reporting seen at another medical center prior to current medical center 1/3/13 admission for chest pain. Ruled out MI at that time. The following information was obtained through follow-up and/or provided by the government. 05/03/2013 Death Certificate received. Final Cause of Death: Pulmonary Embolus due to/or as a consequence of Guillain Barre.


Changed on 9/14/2017

VAERS ID: 482371 Before After
VAERS Form:(blank) 1
Age:65.0
Sex:Male
Location:Virginia
Vaccinated:2012-10-24
Onset:0000-00-00
Submitted:2013-01-24
Entered:2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206101W / 2 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Aphasia, Asthenia, Chest pain, Death, Gait disturbance, Guillain-Barre syndrome, Oedema peripheral

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Chronic kidney diseas, hypertension, gout
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA13002

Write-up: Hospitalized 12/12/12 through 12/22/12 at medical center. Complaints of 6 months'' increasing edema in hands and feet, current unsteady gait, decreased strength. Diagnosed with Guillain-Barre Syndrome. Readmit 1/3/13 with worsening weakness, dysphasia. 1/5/13, expired during transport by ambulance. Stopped at community hospital while en route. DOA at community hospital. Medical center reporting seen at another medical center prior to current medical center 1/3/13 admission for chest pain. Ruled out MI at that time.


Changed on 2/14/2018

VAERS ID: 482371 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Virginia
Vaccinated:2012-10-24
Onset:0000-00-00
Submitted:2013-01-24
Entered:2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206101W / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Aphasia, Asthenia, Chest pain, Death, Gait disturbance, Guillain-Barre syndrome, Oedema peripheral

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Chronic kidney diseas, hypertension, gout
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA13002

Write-up: Hospitalized 12/12/12 through 12/22/12 at medical center. Complaints of 6 months'' increasing edema in hands and feet, current unsteady gait, decreased strength. Diagnosed with Guillain-Barre Syndrome. Readmit 1/3/13 with worsening weakness, dysphasia. 1/5/13, expired during transport by ambulance. Stopped at community hospital while en route. DOA at community hospital. Medical center reporting seen at another medical center prior to current medical center 1/3/13 admission for chest pain. Ruled out MI at that time.


Changed on 6/14/2018

VAERS ID: 482371 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Virginia
Vaccinated:2012-10-24
Onset:0000-00-00
Submitted:2013-01-24
Entered:2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206101W / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Aphasia, Asthenia, Chest pain, Death, Gait disturbance, Guillain-Barre syndrome, Oedema peripheral

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Chronic kidney diseas, hypertension, gout
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA13002

Write-up: Hospitalized 12/12/12 through 12/22/12 at medical center. Complaints of 6 months'' increasing edema in hands and feet, current unsteady gait, decreased strength. Diagnosed with Guillain-Barre Syndrome. Readmit 1/3/13 with worsening weakness, dysphasia. 1/5/13, expired during transport by ambulance. Stopped at community hospital while en route. DOA at community hospital. Medical center reporting seen at another medical center prior to current medical center 1/3/13 admission for chest pain. Ruled out MI at that time.


Changed on 8/14/2018

VAERS ID: 482371 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Virginia
Vaccinated:2012-10-24
Onset:0000-00-00
Submitted:2013-01-24
Entered:2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206101W / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Aphasia, Asthenia, Chest pain, Death, Gait disturbance, Guillain-Barre syndrome, Oedema peripheral

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Chronic kidney diseas, hypertension, gout
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA13002

Write-up: Hospitalized 12/12/12 through 12/22/12 at medical center. Complaints of 6 months'' increasing edema in hands and feet, current unsteady gait, decreased strength. Diagnosed with Guillain-Barre Syndrome. Readmit 1/3/13 with worsening weakness, dysphasia. 1/5/13, expired during transport by ambulance. Stopped at community hospital while en route. DOA at community hospital. Medical center reporting seen at another medical center prior to current medical center 1/3/13 admission for chest pain. Ruled out MI at that time.


Changed on 9/14/2018

VAERS ID: 482371 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Virginia
Vaccinated:2012-10-24
Onset:0000-00-00
Submitted:2013-01-24
Entered:2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206101W / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Aphasia, Asthenia, Chest pain, Death, Gait disturbance, Guillain-Barre syndrome, Oedema peripheral

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Chronic kidney diseas, hypertension, gout
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA13002

Write-up: Hospitalized 12/12/12 through 12/22/12 at medical center. Complaints of 6 months'' increasing edema in hands and feet, current unsteady gait, decreased strength. Diagnosed with Guillain-Barre Syndrome. Readmit 1/3/13 with worsening weakness, dysphasia. 1/5/13, expired during transport by ambulance. Stopped at community hospital while en route. DOA at community hospital. Medical center reporting seen at another medical center prior to current medical center 1/3/13 admission for chest pain. Ruled out MI at that time.


Changed on 10/14/2018

VAERS ID: 482371 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:Virginia
Vaccinated:2012-10-24
Onset:0000-00-00
Submitted:2013-01-24
Entered:2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206101W / 3 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Aphasia, Asthenia, Chest pain, Death, Gait disturbance, Guillain-Barre syndrome, Oedema peripheral

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Chronic kidney diseas, hypertension, gout
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA13002

Write-up: Hospitalized 12/12/12 through 12/22/12 at medical center. Complaints of 6 months'' increasing edema in hands and feet, current unsteady gait, decreased strength. Diagnosed with Guillain-Barre Syndrome. Readmit 1/3/13 with worsening weakness, dysphasia. 1/5/13, expired during transport by ambulance. Stopped at community hospital while en route. DOA at community hospital. Medical center reporting seen at another medical center prior to current medical center 1/3/13 admission for chest pain. Ruled out MI at that time.

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