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This is VAERS ID 63218

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 63218
VAERS Form:
Age:81.7
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938145 / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: NEUROPATHY

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type': intestinal pseudo-obstruction

Write-up: polyneuropathy p/influenza vax;


Changed on 12/8/2009

VAERS ID: 63218 Before After
VAERS Form:
Age:81.7
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-08 1994-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH WYETH PHARMACEUTICALS, INC 4938145 / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Neuropathy, NEUROPATHY

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type': intestinal pseudo-obstruction (blank)

Write-up: polyneuropathy p/influenza vax;


Changed on 8/31/2010

VAERS ID: 63218 Before After
VAERS Form:
Age:81.7
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4938145 / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type':

Write-up: polyneuropathy p/influenza vax;


Changed on 7/7/2013

VAERS ID: 63218 Before After
VAERS Form:
Age:81.7
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938145 / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938145 / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type':

Write-up: polyneuropathy p/influenza vax;


Changed on 12/14/2016

VAERS ID: 63218 Before After
VAERS Form:
Age:81.7
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938145 / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938145 / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type':

Write-up: polyneuropathy p/influenza vax;


Changed on 2/14/2017

VAERS ID: 63218 Before After
VAERS Form:
Age:81.7 81.0
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938145 / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type':

Write-up: polyneuropathy p/influenza vax;


Changed on 5/14/2017

VAERS ID: 63218 Before After
VAERS Form:
Age:81.0
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938145 / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk unk~ ()~~~In patient
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type':

Write-up: polyneuropathy p/influenza vax;


Changed on 9/14/2017

VAERS ID: 63218 Before After
VAERS Form:(blank) 1
Age:81.0
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938145 / - UNK - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk~ ()~~~In patient
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type':

Write-up: polyneuropathy p/influenza vax;


Changed on 2/14/2018

VAERS ID: 63218 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938145 / UNK - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk~ ()~~~In patient
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type':

Write-up: polyneuropathy p/influenza vax;


Changed on 6/14/2018

VAERS ID: 63218 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938145 / UNK - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk~ ()~~~In patient
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type':

Write-up: polyneuropathy p/influenza vax;


Changed on 8/14/2018

VAERS ID: 63218 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938145 / UNK - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk~ ()~~~In patient
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type':

Write-up: polyneuropathy p/influenza vax;


Changed on 9/14/2018

VAERS ID: 63218 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938145 / UNK - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk~ ()~~~In patient
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type':

Write-up: polyneuropathy p/influenza vax;


Changed on 10/14/2018

VAERS ID: 63218 Before After
VAERS Form:1
Age:81.0
Sex:Male
Location:Montana
Vaccinated:1993-10-08
Onset:1993-11-01
Submitted:1994-05-24
Entered:1994-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938145 / UNK - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Neuropathy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: unk~ ()~~~In patient
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Allergies:
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC 'Split Type':

Write-up: polyneuropathy p/influenza vax;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=63218&WAYBACKHISTORY=ON


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