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This is VAERS ID 59828

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 59828
VAERS Form:
Age:58.9
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1993-1994 EVANS MED & LEDERLE / LEDERLE 631923 / 0 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND, PNEUMONIA, RESPIRAT DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


Changed on 12/8/2009

VAERS ID: 59828 Before After
VAERS Form:
Age:58.9
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-19 1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1993-1994 EVANS MED & LEDERLE INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LEDERLE LABORATORIES 631923 / 0 LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder, GUILLAIN BARRE SYND, PNEUMONIA, RESPIRAT DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


Changed on 7/7/2013

VAERS ID: 59828 Before After
VAERS Form:
Age:58.9
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 631923 / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 631923 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


Changed on 2/14/2017

VAERS ID: 59828 Before After
VAERS Form:
Age:58.9 58.0
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 631923 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


Changed on 5/14/2017

VAERS ID: 59828 Before After
VAERS Form:
Age:58.0
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 631923 / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


Changed on 9/14/2017

VAERS ID: 59828 Before After
VAERS Form:(blank) 1
Age:58.0
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 631923 / 0 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


Changed on 2/14/2018

VAERS ID: 59828 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 631923 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


Changed on 6/14/2018

VAERS ID: 59828 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 631923 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


Changed on 8/14/2018

VAERS ID: 59828 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 631923 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


Changed on 9/14/2018

VAERS ID: 59828 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 631923 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


Changed on 10/14/2018

VAERS ID: 59828 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 631923 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


Changed on 12/24/2020

VAERS ID: 59828 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 631923 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;


Changed on 12/30/2020

VAERS ID: 59828 Before After
VAERS Form:1
Age:58.0
Sex:Male
Location:Georgia
Vaccinated:1993-10-07
Onset:1993-10-21
Submitted:1993-11-19
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 631923 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Guillain-Barre syndrome, Pneumonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-11-09
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: NONE
Preexisting Conditions: diabetes, hypertension, obesity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93223

Write-up: Pt had hx of diabetes, elevated BP & obesity; devel GBS approx 2 wks p/vax; devel pneumonia & was put on ventilater;

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=59828&WAYBACKHISTORY=ON


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