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This is VAERS ID 64533

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 64533
VAERS Form:
Age:82.1
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938141 / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: HEADACHE, CONFUS, HEART ARREST, ENCEPHALOPATHY, INCONTIN URIN

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type':

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 12/8/2009

VAERS ID: 64533 Before After
VAERS Form:
Age:82.1
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-07-30 1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH WYETH PHARMACEUTICALS, INC 4938141 / 0 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence, HEADACHE, CONFUS, HEART ARREST, ENCEPHALOPATHY, INCONTIN URIN

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': (blank) 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 8/31/2010

VAERS ID: 64533 Before After
VAERS Form:
Age:82.1
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4938141 / 0 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 7/7/2013

VAERS ID: 64533 Before After
VAERS Form:
Age:82.1
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 0 - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 0 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 12/14/2016

VAERS ID: 64533 Before After
VAERS Form:
Age:82.1
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 0 - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 0 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 2/14/2017

VAERS ID: 64533 Before After
VAERS Form:
Age:82.1 82.0
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 0 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 5/14/2017

VAERS ID: 64533 Before After
VAERS Form:
Age:82.0
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 0 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 9/14/2017

VAERS ID: 64533 Before After
VAERS Form:(blank) 1
Age:82.0
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 0 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 2/14/2018

VAERS ID: 64533 Before After
VAERS Form:1
Age:82.0
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 6/14/2018

VAERS ID: 64533 Before After
VAERS Form:1
Age:82.0
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 8/14/2018

VAERS ID: 64533 Before After
VAERS Form:1
Age:82.0
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 9/14/2018

VAERS ID: 64533 Before After
VAERS Form:1
Age:82.0
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 10/14/2018

VAERS ID: 64533 Before After
VAERS Form:1
Age:82.0
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 12/24/2020

VAERS ID: 64533 Before After
VAERS Form:1
Age:82.0
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;


Changed on 12/30/2020

VAERS ID: 64533 Before After
VAERS Form:1
Age:82.0
Sex:Male
Location:Michigan
Vaccinated:1993-09-20
Onset:1993-09-30
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938141 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Confusional state, Encephalopathy, Headache, Personality disorder, Stupor, Urinary incontinence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1993-11-05
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: 47     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: chronic low wbcs;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: spinal tap, bc, nl; mri brain, non diagnostic;
CDC 'Split Type': 893315001J

Write-up: pt recvd vax & devel headache, became quiet & disoriented; episode of incontinence, & began exhibiting unusual behavior; pt taken to hosp & dx w/ encephalopathy; pt was unresponsive & sufferred a cardiac arrest;

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