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This is VAERS ID 61058

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 61058
VAERS Form:
Age:69.3
Sex:Female
Location:New York
Vaccinated:1992-10-12
Onset:1992-11-12
Submitted:1994-03-09
Entered:1994-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1993-1994 EVANS MED & LEDERLE / LEDERLE 337916 / 0 A / -

Administered by: Private      Purchased by: Unknown
Symptoms: APNEA, NEUROPATHY, HEART FAIL, NECK RIGID, FOOT DROP

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC 'Split Type':

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


Changed on 12/8/2009

VAERS ID: 61058 Before After
VAERS Form:
Age:69.3
Sex:Female
Location:New York
Vaccinated:1992-10-12
Onset:1992-11-12
Submitted:1994-03-09
Entered:1994-04-01 1994-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1993-1994 EVANS MED & LEDERLE INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LEDERLE LABORATORIES 337916 / 0 A / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Peroneal nerve palsy, Pruritus, Speech disorder, Nuchal rigidity, APNEA, NEUROPATHY, HEART FAIL, NECK RIGID, FOOT DROP

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC 'Split Type':

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


Changed on 7/7/2013

VAERS ID: 61058 Before After
VAERS Form:
Age:69.3
Sex:Female
Location:New York
Vaccinated:1992-10-12
Onset:1992-11-12
Submitted:1994-03-09
Entered:1994-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 337916 / 0 A / -
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 337916 / 0 A / -

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Peroneal nerve palsy, Pruritus, Speech disorder, Nuchal rigidity

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC 'Split Type':

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


Changed on 2/14/2017

VAERS ID: 61058 Before After
VAERS Form:
Age:69.3 69.0
Sex:Female
Location:New York
Vaccinated:1992-10-12
Onset:1992-11-12
Submitted:1994-03-09
Entered:1994-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 337916 / 0 A / -

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Peroneal nerve palsy, Pruritus, Speech disorder, Nuchal rigidity

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC 'Split Type':

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


Changed on 5/14/2017

VAERS ID: 61058 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:New York
Vaccinated:1992-10-12
Onset:1992-11-12
Submitted:1994-03-09
Entered:1994-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 337916 / 0 A - / - A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Peroneal nerve palsy, Pruritus, Speech disorder, Nuchal rigidity

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC 'Split Type':

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


Changed on 9/14/2017

VAERS ID: 61058 Before After
VAERS Form:(blank) 1
Age:69.0
Sex:Female
Location:New York
Vaccinated:1992-10-12
Onset:1992-11-12
Submitted:1994-03-09
Entered:1994-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 337916 / 0 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Peroneal nerve palsy, Pruritus, Speech disorder, Nuchal rigidity

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC 'Split Type':

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


Changed on 2/14/2018

VAERS ID: 61058 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:New York
Vaccinated:1992-10-12
Onset:1992-11-12
Submitted:1994-03-09
Entered:1994-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 337916 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Peroneal nerve palsy, Pruritus, Speech disorder, Nuchal rigidity

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC 'Split Type':

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


Changed on 6/14/2018

VAERS ID: 61058 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:New York
Vaccinated:1992-10-12
Onset:1992-11-12
Submitted:1994-03-09
Entered:1994-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 337916 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Peroneal nerve palsy, Pruritus, Speech disorder, Nuchal rigidity

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC 'Split Type':

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


Changed on 8/14/2018

VAERS ID: 61058 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:New York
Vaccinated:1992-10-12
Onset:1992-11-12
Submitted:1994-03-09
Entered:1994-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 337916 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Peroneal nerve palsy, Pruritus, Speech disorder, Nuchal rigidity

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC 'Split Type':

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


Changed on 9/14/2018

VAERS ID: 61058 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:New York
Vaccinated:1992-10-12
Onset:1992-11-12
Submitted:1994-03-09
Entered:1994-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 337916 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Peroneal nerve palsy, Pruritus, Speech disorder, Nuchal rigidity

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC 'Split Type':

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


Changed on 10/14/2018

VAERS ID: 61058 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:New York
Vaccinated:1992-10-12
Onset:1992-11-12
Submitted:1994-03-09
Entered:1994-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 337916 / 1 - / A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Peroneal nerve palsy, Pruritus, Speech disorder, Nuchal rigidity

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC 'Split Type':

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch

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