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This is VAERS ID 55821

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 55821
VAERS Form:
Age:59.8
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1992-1993 / WYETH 4928136 / - LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: NEUROPATHY, MYELITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type':

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;


Changed on 12/8/2009

VAERS ID: 55821 Before After
VAERS Form:
Age:59.8
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-13 1993-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1992-1993 INFLUENZA (SEASONAL) (NO BRAND NAME, 92-93) / WYETH WYETH PHARMACEUTICALS, INC 4928136 / - LA / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Myelitis, Neuropathy, NEUROPATHY, MYELITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type': (blank) MI93120

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;


Changed on 8/31/2010

VAERS ID: 55821 Before After
VAERS Form:
Age:59.8
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 92-93) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4928136 / - LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type': MI93120

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;


Changed on 7/7/2013

VAERS ID: 55821 Before After
VAERS Form:
Age:59.8
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928136 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928136 / - LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type': MI93120

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;


Changed on 12/14/2016

VAERS ID: 55821 Before After
VAERS Form:
Age:59.8
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928136 / - LA / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928136 / - LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type': MI93120

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;


Changed on 2/14/2017

VAERS ID: 55821 Before After
VAERS Form:
Age:59.8 59.0
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928136 / - LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type': MI93120

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;


Changed on 5/14/2017

VAERS ID: 55821 Before After
VAERS Form:
Age:59.0
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928136 / - LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type': MI93120

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;


Changed on 9/14/2017

VAERS ID: 55821 Before After
VAERS Form:(blank) 1
Age:59.0
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928136 / - UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type': MI93120

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;


Changed on 2/14/2018

VAERS ID: 55821 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928136 / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type': MI93120

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;


Changed on 6/14/2018

VAERS ID: 55821 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928136 / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type': MI93120

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;


Changed on 8/14/2018

VAERS ID: 55821 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928136 / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type': MI93120

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;


Changed on 9/14/2018

VAERS ID: 55821 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928136 / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type': MI93120

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;


Changed on 10/14/2018

VAERS ID: 55821 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Michigan
Vaccinated:1992-10-05
Onset:1992-10-25
Submitted:1993-07-25
Entered:1993-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928136 / UNK LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Myelitis, Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI x 4; LP lab;
CDC 'Split Type': MI93120

Write-up: pt recvd vax 5OCT92 & devel neurological s/s T11-T12 26OCT92; MRI''s, LP lab etc; dx acute transverse myelitis w/profound neurological residue; deficit still present 10 months later;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=55821&WAYBACKHISTORY=ON


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