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This is VAERS ID 64504

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 64504
VAERS Form:
Age:67.1
Sex:Female
Location:Tennessee
Vaccinated:1993-10-11
Onset:1993-11-06
Submitted:1994-06-09
Entered:1994-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1993-1994 EVANS MED & LEDERLE / LEDERLE 361923 / 1 A / -

Administered by: Private      Purchased by: Unknown
Symptoms: NEUROPATHY, PAIN, MYELITIS, MYASTHENIA, ATROPHY MUSCLE

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations: none;
Other Medications: procardia xl / premarin; dyazide / motrin;
Current Illness: none;
Preexisting Conditions: hypertension; arthritis;
Allergies:
Diagnostic Lab Data: MRI of c spine: results not provided;
CDC 'Split Type': hypertension; arthritis;

Write-up: pt recvd vax; pt devel paresis of all four extremities; dx: transverse myelitis;


Changed on 12/8/2009

VAERS ID: 64504 Before After
VAERS Form:
Age:67.1
Sex:Female
Location:Tennessee
Vaccinated:1993-10-11
Onset:1993-11-06
Submitted:1994-06-09
Entered:1994-07-12 1994-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLU-IMUNE 1993-1994 EVANS MED & LEDERLE INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LEDERLE LABORATORIES 361923 / 1 A / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Muscle atrophy, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Quadriplegia, NEUROPATHY, PAIN, MYELITIS, MYASTHENIA, ATROPHY MUSCLE

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations: none;
Other Medications: procardia xl / premarin; dyazide / motrin;
Current Illness: none;
Preexisting Conditions: hypertension; arthritis;
Allergies:
Diagnostic Lab Data: MRI of c spine: results not provided;
CDC 'Split Type': hypertension; arthritis; 940120401

Write-up: pt recvd vax; pt devel paresis of all four extremities; dx: transverse myelitis;


Changed on 7/7/2013

VAERS ID: 64504 Before After
VAERS Form:
Age:67.1
Sex:Female
Location:Tennessee
Vaccinated:1993-10-11
Onset:1993-11-06
Submitted:1994-06-09
Entered:1994-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 361923 / 1 A / -
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 361923 / 1 A / -

Administered by: Private      Purchased by: Other
Symptoms: Muscle atrophy, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Quadriplegia

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations: none;
Other Medications: procardia xl / premarin; dyazide / motrin;
Current Illness: none;
Preexisting Conditions: hypertension; arthritis;
Allergies:
Diagnostic Lab Data: MRI of c spine: results not provided;
CDC 'Split Type': 940120401

Write-up: pt recvd vax; pt devel paresis of all four extremities; dx: transverse myelitis;


Changed on 2/14/2017

VAERS ID: 64504 Before After
VAERS Form:
Age:67.1 67.0
Sex:Female
Location:Tennessee
Vaccinated:1993-10-11
Onset:1993-11-06
Submitted:1994-06-09
Entered:1994-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 361923 / 1 A / -

Administered by: Private      Purchased by: Other
Symptoms: Muscle atrophy, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Quadriplegia

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations: none;
Other Medications: procardia xl / premarin; dyazide / motrin;
Current Illness: none;
Preexisting Conditions: hypertension; arthritis;
Allergies:
Diagnostic Lab Data: MRI of c spine: results not provided;
CDC 'Split Type': 940120401

Write-up: pt recvd vax; pt devel paresis of all four extremities; dx: transverse myelitis;


Changed on 5/14/2017

VAERS ID: 64504 Before After
VAERS Form:
Age:67.0
Sex:Female
Location:Tennessee
Vaccinated:1993-10-11
Onset:1993-11-06
Submitted:1994-06-09
Entered:1994-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 361923 / 1 A - / - A

Administered by: Private      Purchased by: Other
Symptoms: Muscle atrophy, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Quadriplegia

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations: none; none;~ ()~~~In patient
Other Medications: procardia xl / premarin; dyazide / motrin;
Current Illness: none;
Preexisting Conditions: hypertension; arthritis;
Allergies:
Diagnostic Lab Data: MRI of c spine: results not provided;
CDC 'Split Type': 940120401

Write-up: pt recvd vax; pt devel paresis of all four extremities; dx: transverse myelitis;


Changed on 9/14/2017

VAERS ID: 64504 Before After
VAERS Form:(blank) 1
Age:67.0
Sex:Female
Location:Tennessee
Vaccinated:1993-10-11
Onset:1993-11-06
Submitted:1994-06-09
Entered:1994-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 361923 / 1 2 - / A

Administered by: Private      Purchased by: Other
Symptoms: Muscle atrophy, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Quadriplegia

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations: none;~ ()~~~In patient
Other Medications: procardia xl / premarin; dyazide / motrin;
Current Illness: none;
Preexisting Conditions: hypertension; arthritis;
Allergies:
Diagnostic Lab Data: MRI of c spine: results not provided;
CDC 'Split Type': 940120401

Write-up: pt recvd vax; pt devel paresis of all four extremities; dx: transverse myelitis;


Changed on 2/14/2018

VAERS ID: 64504 Before After
VAERS Form:1
Age:67.0
Sex:Female
Location:Tennessee
Vaccinated:1993-10-11
Onset:1993-11-06
Submitted:1994-06-09
Entered:1994-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 361923 / 2 - / A

Administered by: Private      Purchased by: Other
Symptoms: Muscle atrophy, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Quadriplegia

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations: none;~ ()~~~In patient
Other Medications: procardia xl / premarin; dyazide / motrin;
Current Illness: none;
Preexisting Conditions: hypertension; arthritis;
Allergies:
Diagnostic Lab Data: MRI of c spine: results not provided;
CDC 'Split Type': 940120401

Write-up: pt recvd vax; pt devel paresis of all four extremities; dx: transverse myelitis;


Changed on 6/14/2018

VAERS ID: 64504 Before After
VAERS Form:1
Age:67.0
Sex:Female
Location:Tennessee
Vaccinated:1993-10-11
Onset:1993-11-06
Submitted:1994-06-09
Entered:1994-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 361923 / 2 - / A

Administered by: Private      Purchased by: Other
Symptoms: Muscle atrophy, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Quadriplegia

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations: none;~ ()~~~In patient
Other Medications: procardia xl / premarin; dyazide / motrin;
Current Illness: none;
Preexisting Conditions: hypertension; arthritis;
Allergies:
Diagnostic Lab Data: MRI of c spine: results not provided;
CDC 'Split Type': 940120401

Write-up: pt recvd vax; pt devel paresis of all four extremities; dx: transverse myelitis;


Changed on 8/14/2018

VAERS ID: 64504 Before After
VAERS Form:1
Age:67.0
Sex:Female
Location:Tennessee
Vaccinated:1993-10-11
Onset:1993-11-06
Submitted:1994-06-09
Entered:1994-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 361923 / 2 - / A

Administered by: Private      Purchased by: Other
Symptoms: Muscle atrophy, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Quadriplegia

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations: none;~ ()~~~In patient
Other Medications: procardia xl / premarin; dyazide / motrin;
Current Illness: none;
Preexisting Conditions: hypertension; arthritis;
Allergies:
Diagnostic Lab Data: MRI of c spine: results not provided;
CDC 'Split Type': 940120401

Write-up: pt recvd vax; pt devel paresis of all four extremities; dx: transverse myelitis;


Changed on 9/14/2018

VAERS ID: 64504 Before After
VAERS Form:1
Age:67.0
Sex:Female
Location:Tennessee
Vaccinated:1993-10-11
Onset:1993-11-06
Submitted:1994-06-09
Entered:1994-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 361923 / 2 - / A

Administered by: Private      Purchased by: Other
Symptoms: Muscle atrophy, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Quadriplegia

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations: none;~ ()~~~In patient
Other Medications: procardia xl / premarin; dyazide / motrin;
Current Illness: none;
Preexisting Conditions: hypertension; arthritis;
Allergies:
Diagnostic Lab Data: MRI of c spine: results not provided;
CDC 'Split Type': 940120401

Write-up: pt recvd vax; pt devel paresis of all four extremities; dx: transverse myelitis;


Changed on 10/14/2018

VAERS ID: 64504 Before After
VAERS Form:1
Age:67.0
Sex:Female
Location:Tennessee
Vaccinated:1993-10-11
Onset:1993-11-06
Submitted:1994-06-09
Entered:1994-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 361923 / 2 - / A

Administered by: Private      Purchased by: Other
Symptoms: Muscle atrophy, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Quadriplegia

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations: none;~ ()~~~In patient
Other Medications: procardia xl / premarin; dyazide / motrin;
Current Illness: none;
Preexisting Conditions: hypertension; arthritis;
Allergies:
Diagnostic Lab Data: MRI of c spine: results not provided;
CDC 'Split Type': 940120401

Write-up: pt recvd vax; pt devel paresis of all four extremities; dx: transverse myelitis;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=64504&WAYBACKHISTORY=ON


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