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This is VAERS ID 58137

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58137
VAERS Form:
Age:46.6
Sex:Male
Location:Maryland
Vaccinated:1993-10-12
Onset:1993-10-14
Submitted:1993-12-07
Entered:1993-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 / CONNAUGHT LABS 3J41026 / - - / -

Administered by: Military      Purchased by: Unknown
Symptoms: AGITATION, ENCEPHALITIS, CONFUS, ASTHENIA, ANEMIA

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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


Changed on 12/8/2009

VAERS ID: 58137 Before After
VAERS Form:
Age:46.6
Sex:Male
Location:Maryland
Vaccinated:1993-10-12
Onset:1993-10-14
Submitted:1993-12-07
Entered:1993-12-20 1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 INFLUENZA (SEASONAL) (FLUZONE 93-94) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3J41026 / - - / -

Administered by: Military      Purchased by: Unknown Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor, AGITATION, ENCEPHALITIS, CONFUS, ASTHENIA, ANEMIA

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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


Changed on 8/31/2010

VAERS ID: 58137 Before After
VAERS Form:
Age:46.6
Sex:Male
Location:Maryland
Vaccinated:1993-10-12
Onset:1993-10-14
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 93-94) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor

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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


Changed on 7/7/2013

VAERS ID: 58137 Before After
VAERS Form:
Age:46.6
Sex:Male
Location:Maryland
Vaccinated:1993-10-12
Onset:1993-10-14
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor

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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


Changed on 2/14/2017

VAERS ID: 58137 Before After
VAERS Form:
Age:46.6 46.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-12
Onset:1993-10-14
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor

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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


Changed on 5/14/2017

VAERS ID: 58137 Before After
VAERS Form:
Age:46.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-12
Onset:1993-10-14
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor

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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


Changed on 9/14/2017

VAERS ID: 58137 Before After
VAERS Form:(blank) 1
Age:46.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-12
Onset:1993-10-14
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / - UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor

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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


Changed on 2/14/2018

VAERS ID: 58137 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-12
Onset:1993-10-14
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor

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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


Changed on 6/14/2018

VAERS ID: 58137 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-12
Onset:1993-10-14
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor

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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


Changed on 8/14/2018

VAERS ID: 58137 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-12
Onset:1993-10-14
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor

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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


Changed on 9/14/2018

VAERS ID: 58137 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-12
Onset:1993-10-14
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor

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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


Changed on 10/14/2018

VAERS ID: 58137 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Maryland
Vaccinated:1993-10-12
Onset:1993-10-14
Submitted:1993-12-07
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor

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? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;

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