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This is VAERS ID 69658

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 69658
VAERS Form:
Age:
Sex:Male
Location:Alabama
Vaccinated:1992-11-17
Onset:0000-00-00
Submitted:1994-11-28
Entered:1994-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1994-1995 / WYETH 4928235 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: NEUROPATHY, GUILLAIN BARRE SYND, ALLERG REACT, DEPRESSION, IMMUNE SYSTEM DIS

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: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of hypertension & coronary artery disease;
Allergies:
Diagnostic Lab Data: LP-results unspecified;
CDC 'Split Type': pt has a hx of hypertension & coronary artery disease;

Write-up: pt recvd 17NOV92 & pt exp a hypersensitivity react permanent injury to immune system, disorder in immune system, rheumatoid like condition, inflammatory condition; devel GBS assoc w/partial paralysis, polyneuropathy, numbness, facial weak


Changed on 12/8/2009

VAERS ID: 69658 Before After
VAERS Form:
Age:
Sex:Male
Location:Alabama
Vaccinated:1992-11-17
Onset:0000-00-00
Submitted:1994-11-28
Entered:1994-12-22 1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1994-1995 INFLUENZA (SEASONAL) (FLUSHIELD 94-95) / WYETH WYETH PHARMACEUTICALS, INC 4928235 / - - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Condition aggravated, Depression, Guillain-Barre syndrome, Hypersensitivity, Immune system disorder, Neuropathy, Paraesthesia, Paralysis, NEUROPATHY, GUILLAIN BARRE SYND, ALLERG REACT, DEPRESSION, IMMUNE SYSTEM DIS

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: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of hypertension & coronary artery disease;
Allergies:
Diagnostic Lab Data: LP-results unspecified;
CDC 'Split Type': pt has a hx of hypertension & coronary artery disease; 894342006S

Write-up: pt recvd 17NOV92 & pt exp a hypersensitivity react permanent injury to immune system, disorder in immune system, rheumatoid like condition, inflammatory condition; devel GBS assoc w/partial paralysis, polyneuropathy, numbness, facial weak


Changed on 8/31/2010

VAERS ID: 69658 Before After
VAERS Form:
Age:
Sex:Male
Location:Alabama
Vaccinated:1992-11-17
Onset:0000-00-00
Submitted:1994-11-28
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 94-95) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4928235 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Depression, Guillain-Barre syndrome, Hypersensitivity, Immune system disorder, Neuropathy, Paraesthesia, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of hypertension & coronary artery disease;
Allergies:
Diagnostic Lab Data: LP-results unspecified;
CDC 'Split Type': 894342006S

Write-up: pt recvd 17NOV92 & pt exp a hypersensitivity react permanent injury to immune system, disorder in immune system, rheumatoid like condition, inflammatory condition; devel GBS assoc w/partial paralysis, polyneuropathy, numbness, facial weak


Changed on 7/7/2013

VAERS ID: 69658 Before After
VAERS Form:
Age:
Sex:Male
Location:Alabama
Vaccinated:1992-11-17
Onset:0000-00-00
Submitted:1994-11-28
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4928235 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4928235 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Depression, Guillain-Barre syndrome, Hypersensitivity, Immune system disorder, Neuropathy, Paraesthesia, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of hypertension & coronary artery disease;
Allergies:
Diagnostic Lab Data: LP-results unspecified;
CDC 'Split Type': 894342006S

Write-up: pt recvd 17NOV92 & pt exp a hypersensitivity react permanent injury to immune system, disorder in immune system, rheumatoid like condition, inflammatory condition; devel GBS assoc w/partial paralysis, polyneuropathy, numbness, facial weak


Changed on 5/14/2017

VAERS ID: 69658 Before After
VAERS Form:
Age:
Sex:Male
Location:Alabama
Vaccinated:1992-11-17
Onset:0000-00-00
Submitted:1994-11-28
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4928235 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Depression, Guillain-Barre syndrome, Hypersensitivity, Immune system disorder, Neuropathy, Paraesthesia, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of hypertension & coronary artery disease;
Allergies:
Diagnostic Lab Data: LP-results unspecified;
CDC 'Split Type': 894342006S

Write-up: pt recvd 17NOV92 & pt exp a hypersensitivity react permanent injury to immune system, disorder in immune system, rheumatoid like condition, inflammatory condition; devel GBS assoc w/partial paralysis, polyneuropathy, numbness, facial weak


Changed on 9/14/2017

VAERS ID: 69658 Before After
VAERS Form:(blank) 1
Age:
Sex:Male
Location:Alabama
Vaccinated:1992-11-17
Onset:0000-00-00
Submitted:1994-11-28
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4928235 / - UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Depression, Guillain-Barre syndrome, Hypersensitivity, Immune system disorder, Neuropathy, Paraesthesia, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of hypertension & coronary artery disease;
Allergies:
Diagnostic Lab Data: LP-results unspecified;
CDC 'Split Type': 894342006S

Write-up: pt recvd 17NOV92 & pt exp a hypersensitivity react permanent injury to immune system, disorder in immune system, rheumatoid like condition, inflammatory condition; devel GBS assoc w/partial paralysis, polyneuropathy, numbness, facial weak


Changed on 2/14/2018

VAERS ID: 69658 Before After
VAERS Form:1
Age:
Sex:Male
Location:Alabama
Vaccinated:1992-11-17
Onset:0000-00-00
Submitted:1994-11-28
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4928235 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Depression, Guillain-Barre syndrome, Hypersensitivity, Immune system disorder, Neuropathy, Paraesthesia, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of hypertension & coronary artery disease;
Allergies:
Diagnostic Lab Data: LP-results unspecified;
CDC 'Split Type': 894342006S

Write-up: pt recvd 17NOV92 & pt exp a hypersensitivity react permanent injury to immune system, disorder in immune system, rheumatoid like condition, inflammatory condition; devel GBS assoc w/partial paralysis, polyneuropathy, numbness, facial weak


Changed on 6/14/2018

VAERS ID: 69658 Before After
VAERS Form:1
Age:
Sex:Male
Location:Alabama
Vaccinated:1992-11-17
Onset:0000-00-00
Submitted:1994-11-28
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4928235 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Depression, Guillain-Barre syndrome, Hypersensitivity, Immune system disorder, Neuropathy, Paraesthesia, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of hypertension & coronary artery disease;
Allergies:
Diagnostic Lab Data: LP-results unspecified;
CDC 'Split Type': 894342006S

Write-up: pt recvd 17NOV92 & pt exp a hypersensitivity react permanent injury to immune system, disorder in immune system, rheumatoid like condition, inflammatory condition; devel GBS assoc w/partial paralysis, polyneuropathy, numbness, facial weak


Changed on 8/14/2018

VAERS ID: 69658 Before After
VAERS Form:1
Age:
Sex:Male
Location:Alabama
Vaccinated:1992-11-17
Onset:0000-00-00
Submitted:1994-11-28
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4928235 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Depression, Guillain-Barre syndrome, Hypersensitivity, Immune system disorder, Neuropathy, Paraesthesia, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of hypertension & coronary artery disease;
Allergies:
Diagnostic Lab Data: LP-results unspecified;
CDC 'Split Type': 894342006S

Write-up: pt recvd 17NOV92 & pt exp a hypersensitivity react permanent injury to immune system, disorder in immune system, rheumatoid like condition, inflammatory condition; devel GBS assoc w/partial paralysis, polyneuropathy, numbness, facial weak


Changed on 9/14/2018

VAERS ID: 69658 Before After
VAERS Form:1
Age:
Sex:Male
Location:Alabama
Vaccinated:1992-11-17
Onset:0000-00-00
Submitted:1994-11-28
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4928235 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Depression, Guillain-Barre syndrome, Hypersensitivity, Immune system disorder, Neuropathy, Paraesthesia, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of hypertension & coronary artery disease;
Allergies:
Diagnostic Lab Data: LP-results unspecified;
CDC 'Split Type': 894342006S

Write-up: pt recvd 17NOV92 & pt exp a hypersensitivity react permanent injury to immune system, disorder in immune system, rheumatoid like condition, inflammatory condition; devel GBS assoc w/partial paralysis, polyneuropathy, numbness, facial weak


Changed on 10/14/2018

VAERS ID: 69658 Before After
VAERS Form:1
Age:
Sex:Male
Location:Alabama
Vaccinated:1992-11-17
Onset:0000-00-00
Submitted:1994-11-28
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4928235 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Depression, Guillain-Barre syndrome, Hypersensitivity, Immune system disorder, Neuropathy, Paraesthesia, Paralysis

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: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of hypertension & coronary artery disease;
Allergies:
Diagnostic Lab Data: LP-results unspecified;
CDC 'Split Type': 894342006S

Write-up: pt recvd 17NOV92 & pt exp a hypersensitivity react permanent injury to immune system, disorder in immune system, rheumatoid like condition, inflammatory condition; devel GBS assoc w/partial paralysis, polyneuropathy, numbness, facial weak

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=69658&WAYBACKHISTORY=ON


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