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This is VAERS ID 59156

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 59156
VAERS Form:
Age:78.5
Sex:Male
Location:Unknown
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 / CONNAUGHT LABS 3F41142 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: APNEA, GUILLAIN BARRE SYND, PNEUMONIA, RESPIRAT DIS, AV BLOCK COMP

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 12/8/2009

VAERS ID: 59156 Before After
VAERS Form:
Age:78.5
Sex:Male
Location:Unknown
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-21 1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 INFLUENZA (SEASONAL) (FLUZONE 93-94) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3F41142 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis, APNEA, GUILLAIN BARRE SYND, PNEUMONIA, RESPIRAT DIS, AV BLOCK COMP

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 8/31/2010

VAERS ID: 59156 Before After
VAERS Form:
Age:78.5
Sex:Male
Location:Unknown
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 93-94) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 7/7/2013

VAERS ID: 59156 Before After
VAERS Form:
Age:78.5
Sex:Male
Location:Unknown
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 2/14/2017

VAERS ID: 59156 Before After
VAERS Form:
Age:78.5 78.0
Sex:Male
Location:Unknown
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 5/14/2017

VAERS ID: 59156 Before After
VAERS Form:
Age:78.0
Sex:Male
Location:Unknown
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 9/14/2017

VAERS ID: 59156 Before After
VAERS Form:(blank) 1
Age:78.0
Sex:Male
Location:Unknown
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 2/14/2018

VAERS ID: 59156 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:Unknown
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 6/14/2018

VAERS ID: 59156 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:Unknown
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 8/14/2018

VAERS ID: 59156 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:Unknown
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 9/14/2018

VAERS ID: 59156 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:Unknown
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 10/14/2018

VAERS ID: 59156 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:Unknown
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 12/10/2020

VAERS ID: 59156 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:Unknown California
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 12/24/2020

VAERS ID: 59156 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:California
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;


Changed on 12/30/2020

VAERS ID: 59156 Before After
VAERS Form:1
Age:78.0
Sex:Male
Location:California
Vaccinated:1993-10-01
Onset:1993-10-01
Submitted:1994-01-04
Entered:1994-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41142 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Atrioventricular block complete, Guillain-Barre syndrome, Pneumonia, Respiratory disorder, Sepsis

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Ocular Myasthenia Gravis (only Ocular); DIabetes; hypertension;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was given flu vax 1OCT93 & w/in 1 wk devel sx of GBS w/resp failure requiring ventilator support & 3 heart blocks requiring pacemaker; pt devel complication of pneumonia later on ventilator & died secondary to sepsis w/in wks;

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