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This is VAERS ID 57470

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 57470
VAERS Form:
Age:74.1
Sex:Male
Location:Florida
Vaccinated:1993-10-01
Onset:1993-10-17
Submitted:1993-11-10
Entered:1993-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1993-1994 / PARKE-DAVIS 00963P / - A / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 25     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC 'Split Type':

Write-up: poss transverse myelitis w/paralysis from chest down;


Changed on 12/8/2009

VAERS ID: 57470 Before After
VAERS Form:
Age:74.1
Sex:Male
Location:Florida
Vaccinated:1993-10-01
Onset:1993-10-17
Submitted:1993-11-10
Entered:1993-11-24 1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1993-1994 INFLUENZA (SEASONAL) (FLUOGEN 93-94) / PARKE-DAVIS 00963P / - A / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Myelitis, Paralysis, MYELITIS, PARALYSIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 25     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC 'Split Type':

Write-up: poss transverse myelitis w/paralysis from chest down;


Changed on 8/31/2010

VAERS ID: 57470 Before After
VAERS Form:
Age:74.1
Sex:Male
Location:Florida
Vaccinated:1993-10-01
Onset:1993-10-17
Submitted:1993-11-10
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 93-94) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / - A / IM

Administered by: Private      Purchased by: Private
Symptoms: Myelitis, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 25     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC 'Split Type':

Write-up: poss transverse myelitis w/paralysis from chest down;


Changed on 7/7/2013

VAERS ID: 57470 Before After
VAERS Form:
Age:74.1
Sex:Male
Location:Florida
Vaccinated:1993-10-01
Onset:1993-10-17
Submitted:1993-11-10
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / - A / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / - A / IM

Administered by: Private      Purchased by: Private
Symptoms: Myelitis, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 25     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC 'Split Type':

Write-up: poss transverse myelitis w/paralysis from chest down;


Changed on 2/14/2017

VAERS ID: 57470 Before After
VAERS Form:
Age:74.1 74.0
Sex:Male
Location:Florida
Vaccinated:1993-10-01
Onset:1993-10-17
Submitted:1993-11-10
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / - A / IM

Administered by: Private      Purchased by: Private
Symptoms: Myelitis, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 25     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC 'Split Type':

Write-up: poss transverse myelitis w/paralysis from chest down;


Changed on 5/14/2017

VAERS ID: 57470 Before After
VAERS Form:
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1993-10-01
Onset:1993-10-17
Submitted:1993-11-10
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / - A - / IM IM A

Administered by: Private      Purchased by: Private
Symptoms: Myelitis, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 25     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC 'Split Type':

Write-up: poss transverse myelitis w/paralysis from chest down;


Changed on 9/14/2017

VAERS ID: 57470 Before After
VAERS Form:(blank) 1
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1993-10-01
Onset:1993-10-17
Submitted:1993-11-10
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / - UNK - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Myelitis, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 25     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC 'Split Type':

Write-up: poss transverse myelitis w/paralysis from chest down;


Changed on 2/14/2018

VAERS ID: 57470 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1993-10-01
Onset:1993-10-17
Submitted:1993-11-10
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / UNK - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Myelitis, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 25     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC 'Split Type':

Write-up: poss transverse myelitis w/paralysis from chest down;


Changed on 6/14/2018

VAERS ID: 57470 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1993-10-01
Onset:1993-10-17
Submitted:1993-11-10
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / UNK - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Myelitis, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 25     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC 'Split Type':

Write-up: poss transverse myelitis w/paralysis from chest down;


Changed on 8/14/2018

VAERS ID: 57470 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1993-10-01
Onset:1993-10-17
Submitted:1993-11-10
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / UNK - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Myelitis, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 25     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC 'Split Type':

Write-up: poss transverse myelitis w/paralysis from chest down;


Changed on 9/14/2018

VAERS ID: 57470 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1993-10-01
Onset:1993-10-17
Submitted:1993-11-10
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / UNK - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Myelitis, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 25     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC 'Split Type':

Write-up: poss transverse myelitis w/paralysis from chest down;


Changed on 10/14/2018

VAERS ID: 57470 Before After
VAERS Form:1
Age:74.0
Sex:Male
Location:Florida
Vaccinated:1993-10-01
Onset:1993-10-17
Submitted:1993-11-10
Entered:1993-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / UNK - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Myelitis, Paralysis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 25     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC 'Split Type':

Write-up: poss transverse myelitis w/paralysis from chest down;

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