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This is VAERS ID 58359

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58359
VAERS Form:
Age:42.8
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938167 / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: PARESTHESIA, MYASTHENIA, CARCINOMA

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


Changed on 12/8/2009

VAERS ID: 58359 Before After
VAERS Form:
Age:42.8
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-23 1993-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH WYETH PHARMACEUTICALS, INC 4938167 / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia, PARESTHESIA, MYASTHENIA, CARCINOMA

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


Changed on 8/31/2010

VAERS ID: 58359 Before After
VAERS Form:
Age:42.8
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4938167 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


Changed on 7/7/2013

VAERS ID: 58359 Before After
VAERS Form:
Age:42.8
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / - - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


Changed on 12/14/2016

VAERS ID: 58359 Before After
VAERS Form:
Age:42.8
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / - - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


Changed on 2/14/2017

VAERS ID: 58359 Before After
VAERS Form:
Age:42.8 42.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


Changed on 5/14/2017

VAERS ID: 58359 Before After
VAERS Form:
Age:42.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


Changed on 9/14/2017

VAERS ID: 58359 Before After
VAERS Form:(blank) 1
Age:42.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


Changed on 2/14/2018

VAERS ID: 58359 Before After
VAERS Form:1
Age:42.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


Changed on 6/14/2018

VAERS ID: 58359 Before After
VAERS Form:1
Age:42.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


Changed on 8/14/2018

VAERS ID: 58359 Before After
VAERS Form:1
Age:42.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


Changed on 9/14/2018

VAERS ID: 58359 Before After
VAERS Form:1
Age:42.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


Changed on 10/14/2018

VAERS ID: 58359 Before After
VAERS Form:1
Age:42.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-04
Onset:1993-10-15
Submitted:1993-11-24
Entered:1993-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;

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