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This is VAERS ID 67766

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 67766
VAERS Form:
Age:40.1
Sex:Male
Location:Texas
Vaccinated:1993-09-28
Onset:1993-09-28
Submitted:1994-10-23
Entered:1994-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED 359909 / 0 - / -

Administered by: Other      Purchased by: Unknown
Symptoms: SYNCOPE, NEUROPATHY, COMA, EDEMA BRAIN, HEM CEREBR

Life Threatening? Yes
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: 58     Extended hospital stay? Yes
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC 'Split Type':

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.


Changed on 12/8/2009

VAERS ID: 67766 Before After
VAERS Form:
Age:40.1
Sex:Male
Location:Texas
Vaccinated:1993-09-28
Onset:1993-09-28
Submitted:1994-10-23
Entered:1994-11-03 1994-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 359909 / 0 - / -

Administered by: Other      Purchased by: Unknown Private
Symptoms: Cerebral haemorrhage, Coma, Neuropathy, Syncope, Brain oedema, SYNCOPE, NEUROPATHY, COMA, EDEMA BRAIN, HEM CEREBR

Life Threatening? Yes
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: 58     Extended hospital stay? Yes
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC 'Split Type':

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.


Changed on 7/7/2013

VAERS ID: 67766 Before After
VAERS Form:
Age:40.1
Sex:Male
Location:Texas
Vaccinated:1993-09-28
Onset:1993-09-28
Submitted:1994-10-23
Entered:1994-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 0 - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 0 - / -

Administered by: Other      Purchased by: Private
Symptoms: Cerebral haemorrhage, Coma, Neuropathy, Syncope, Brain oedema

Life Threatening? Yes
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: 58     Extended hospital stay? Yes
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC 'Split Type':

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.


Changed on 12/14/2016

VAERS ID: 67766 Before After
VAERS Form:
Age:40.1
Sex:Male
Location:Texas
Vaccinated:1993-09-28
Onset:1993-09-28
Submitted:1994-10-23
Entered:1994-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 0 - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 0 - / -

Administered by: Other      Purchased by: Private
Symptoms: Cerebral haemorrhage, Coma, Neuropathy, Syncope, Brain oedema

Life Threatening? Yes
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: 58     Extended hospital stay? Yes
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC 'Split Type':

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.


Changed on 2/14/2017

VAERS ID: 67766 Before After
VAERS Form:
Age:40.1 40.0
Sex:Male
Location:Texas
Vaccinated:1993-09-28
Onset:1993-09-28
Submitted:1994-10-23
Entered:1994-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 0 - / -

Administered by: Other      Purchased by: Private
Symptoms: Cerebral haemorrhage, Coma, Neuropathy, Syncope, Brain oedema

Life Threatening? Yes
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: 58     Extended hospital stay? Yes
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC 'Split Type':

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.


Changed on 5/14/2017

VAERS ID: 67766 Before After
VAERS Form:
Age:40.0
Sex:Male
Location:Texas
Vaccinated:1993-09-28
Onset:1993-09-28
Submitted:1994-10-23
Entered:1994-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 0 - / -

Administered by: Other      Purchased by: Private
Symptoms: Cerebral haemorrhage, Coma, Neuropathy, Syncope, Brain oedema

Life Threatening? Yes
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: 58     Extended hospital stay? Yes
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC 'Split Type':

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.


Changed on 9/14/2017

VAERS ID: 67766 Before After
VAERS Form:(blank) 1
Age:40.0
Sex:Male
Location:Texas
Vaccinated:1993-09-28
Onset:1993-09-28
Submitted:1994-10-23
Entered:1994-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 0 1 - / -

Administered by: Other      Purchased by: Private
Symptoms: Cerebral haemorrhage, Coma, Neuropathy, Syncope, Brain oedema

Life Threatening? Yes
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: 58     Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC 'Split Type':

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.


Changed on 2/14/2018

VAERS ID: 67766 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:Texas
Vaccinated:1993-09-28
Onset:1993-09-28
Submitted:1994-10-23
Entered:1994-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 1 - / -

Administered by: Other      Purchased by: Private
Symptoms: Cerebral haemorrhage, Coma, Neuropathy, Syncope, Brain oedema

Life Threatening? Yes
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: 58     Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC 'Split Type':

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.


Changed on 6/14/2018

VAERS ID: 67766 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:Texas
Vaccinated:1993-09-28
Onset:1993-09-28
Submitted:1994-10-23
Entered:1994-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 1 - / -

Administered by: Other      Purchased by: Private
Symptoms: Cerebral haemorrhage, Coma, Neuropathy, Syncope, Brain oedema

Life Threatening? Yes
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: 58     Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC 'Split Type':

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.


Changed on 8/14/2018

VAERS ID: 67766 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:Texas
Vaccinated:1993-09-28
Onset:1993-09-28
Submitted:1994-10-23
Entered:1994-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 1 - / -

Administered by: Other      Purchased by: Private
Symptoms: Cerebral haemorrhage, Coma, Neuropathy, Syncope, Brain oedema

Life Threatening? Yes
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: 58     Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC 'Split Type':

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.


Changed on 9/14/2018

VAERS ID: 67766 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:Texas
Vaccinated:1993-09-28
Onset:1993-09-28
Submitted:1994-10-23
Entered:1994-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 1 - / -

Administered by: Other      Purchased by: Private
Symptoms: Cerebral haemorrhage, Coma, Neuropathy, Syncope, Brain oedema

Life Threatening? Yes
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: 58     Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC 'Split Type':

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.


Changed on 10/14/2018

VAERS ID: 67766 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:Texas
Vaccinated:1993-09-28
Onset:1993-09-28
Submitted:1994-10-23
Entered:1994-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 1 - / -

Administered by: Other      Purchased by: Private
Symptoms: Cerebral haemorrhage, Coma, Neuropathy, Syncope, Brain oedema

Life Threatening? Yes
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: 58     Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC 'Split Type':

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.

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