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This is VAERS ID 55955

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 55955
VAERS Form:
Age:51.0
Sex:Female
Location:Georgia
Vaccinated:1990-10-23
Onset:1990-11-03
Submitted:1992-10-28
Entered:1993-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1992-1993 EVANS MED & LEDERLE / LEDERLE - / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: BRAIN SYND ACUTE, ENCEPHALITIS, VISION ABNORM

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': NA

Write-up: plaintiff alleges that as a result of vax 23OCT90, pt was hospitalized on 3NOV90 w/dx of post vaccination focal encephalitis @ time of litigation OCT92; reportedly has permanent brain damage w/severe vision problems;


Changed on 12/8/2009

VAERS ID: 55955 Before After
VAERS Form:
Age:51.0
Sex:Female
Location:Georgia
Vaccinated:1990-10-23
Onset:1990-11-03
Submitted:1992-10-28
Entered:1993-09-15 1993-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1992-1993 EVANS MED & LEDERLE INFLUENZA (SEASONAL) (FLU-IMUNE 92-93) / LEDERLE LEDERLE LABORATORIES - / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Delirium, Encephalitis, Visual disturbance, BRAIN SYND ACUTE, ENCEPHALITIS, VISION ABNORM

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': NA 920357801

Write-up: plaintiff alleges that as a result of vax 23OCT90, pt was hospitalized on 3NOV90 w/dx of post vaccination focal encephalitis @ time of litigation OCT92; reportedly has permanent brain damage w/severe vision problems;


Changed on 8/31/2010

VAERS ID: 55955 Before After
VAERS Form:
Age:51.0
Sex:Female
Location:Georgia
Vaccinated:1990-10-23
Onset:1990-11-03
Submitted:1992-10-28
Entered:1993-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE 92-93) INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Delirium, Encephalitis, Visual disturbance

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920357801

Write-up: plaintiff alleges that as a result of vax 23OCT90, pt was hospitalized on 3NOV90 w/dx of post vaccination focal encephalitis @ time of litigation OCT92; reportedly has permanent brain damage w/severe vision problems;


Changed on 7/7/2013

VAERS ID: 55955 Before After
VAERS Form:
Age:51.0
Sex:Female
Location:Georgia
Vaccinated:1990-10-23
Onset:1990-11-03
Submitted:1992-10-28
Entered:1993-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / - - / -
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Delirium, Encephalitis, Visual disturbance

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920357801

Write-up: plaintiff alleges that as a result of vax 23OCT90, pt was hospitalized on 3NOV90 w/dx of post vaccination focal encephalitis @ time of litigation OCT92; reportedly has permanent brain damage w/severe vision problems;


Changed on 5/14/2017

VAERS ID: 55955 Before After
VAERS Form:
Age:51.0
Sex:Female
Location:Georgia
Vaccinated:1990-10-23
Onset:1990-11-03
Submitted:1992-10-28
Entered:1993-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Delirium, Encephalitis, Visual disturbance

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NA NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920357801

Write-up: plaintiff alleges that as a result of vax 23OCT90, pt was hospitalized on 3NOV90 w/dx of post vaccination focal encephalitis @ time of litigation OCT92; reportedly has permanent brain damage w/severe vision problems;


Changed on 9/14/2017

VAERS ID: 55955 Before After
VAERS Form:(blank) 1
Age:51.0
Sex:Female
Location:Georgia
Vaccinated:1990-10-23
Onset:1990-11-03
Submitted:1992-10-28
Entered:1993-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / - UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Delirium, Encephalitis, Visual disturbance

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920357801

Write-up: plaintiff alleges that as a result of vax 23OCT90, pt was hospitalized on 3NOV90 w/dx of post vaccination focal encephalitis @ time of litigation OCT92; reportedly has permanent brain damage w/severe vision problems;


Changed on 2/14/2018

VAERS ID: 55955 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:Georgia
Vaccinated:1990-10-23
Onset:1990-11-03
Submitted:1992-10-28
Entered:1993-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Delirium, Encephalitis, Visual disturbance

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920357801

Write-up: plaintiff alleges that as a result of vax 23OCT90, pt was hospitalized on 3NOV90 w/dx of post vaccination focal encephalitis @ time of litigation OCT92; reportedly has permanent brain damage w/severe vision problems;


Changed on 6/14/2018

VAERS ID: 55955 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:Georgia
Vaccinated:1990-10-23
Onset:1990-11-03
Submitted:1992-10-28
Entered:1993-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Delirium, Encephalitis, Visual disturbance

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920357801

Write-up: plaintiff alleges that as a result of vax 23OCT90, pt was hospitalized on 3NOV90 w/dx of post vaccination focal encephalitis @ time of litigation OCT92; reportedly has permanent brain damage w/severe vision problems;


Changed on 8/14/2018

VAERS ID: 55955 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:Georgia
Vaccinated:1990-10-23
Onset:1990-11-03
Submitted:1992-10-28
Entered:1993-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Delirium, Encephalitis, Visual disturbance

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920357801

Write-up: plaintiff alleges that as a result of vax 23OCT90, pt was hospitalized on 3NOV90 w/dx of post vaccination focal encephalitis @ time of litigation OCT92; reportedly has permanent brain damage w/severe vision problems;


Changed on 9/14/2018

VAERS ID: 55955 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:Georgia
Vaccinated:1990-10-23
Onset:1990-11-03
Submitted:1992-10-28
Entered:1993-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Delirium, Encephalitis, Visual disturbance

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920357801

Write-up: plaintiff alleges that as a result of vax 23OCT90, pt was hospitalized on 3NOV90 w/dx of post vaccination focal encephalitis @ time of litigation OCT92; reportedly has permanent brain damage w/severe vision problems;


Changed on 10/14/2018

VAERS ID: 55955 Before After
VAERS Form:1
Age:51.0
Sex:Female
Location:Georgia
Vaccinated:1990-10-23
Onset:1990-11-03
Submitted:1992-10-28
Entered:1993-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Delirium, Encephalitis, Visual disturbance

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920357801

Write-up: plaintiff alleges that as a result of vax 23OCT90, pt was hospitalized on 3NOV90 w/dx of post vaccination focal encephalitis @ time of litigation OCT92; reportedly has permanent brain damage w/severe vision problems;

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