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This is VAERS ID 72175

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 72175
VAERS Form:
Age:59.3
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH - / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, ARTHRALGIA, ENCEPHALITIS, MYELITIS, INFECT URIN TRACT

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? No
Previous Vaccinations:
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 12/8/2009

VAERS ID: 72175 Before After
VAERS Form:
Age:59.3
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-03-27 1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH WYETH PHARMACEUTICALS, INC - / - - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance, FEVER, ARTHRALGIA, ENCEPHALITIS, MYELITIS, INFECT URIN TRACT

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? No
Previous Vaccinations:
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 8/31/2010

VAERS ID: 72175 Before After
VAERS Form:
Age:59.3
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations:
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 7/7/2013

VAERS ID: 72175 Before After
VAERS Form:
Age:59.3
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations:
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 12/14/2016

VAERS ID: 72175 Before After
VAERS Form:
Age:59.3
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations:
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 2/14/2017

VAERS ID: 72175 Before After
VAERS Form:
Age:59.3 59.0
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations:
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 5/14/2017

VAERS ID: 72175 Before After
VAERS Form:
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 9/14/2017

VAERS ID: 72175 Before After
VAERS Form:(blank) 1
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 2/14/2018

VAERS ID: 72175 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 6/14/2018

VAERS ID: 72175 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 8/14/2018

VAERS ID: 72175 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 9/14/2018

VAERS ID: 72175 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 10/14/2018

VAERS ID: 72175 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Illinois
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 12/10/2020

VAERS ID: 72175 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Illinois Florida
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 12/24/2020

VAERS ID: 72175 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Florida
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 12/30/2020

VAERS ID: 72175 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Florida
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 5/7/2021

VAERS ID: 72175 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Florida
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;


Changed on 5/14/2021

VAERS ID: 72175 Before After
VAERS Form:1
Age:59.0
Sex:Male
Location:Florida
Vaccinated:1993-11-22
Onset:1993-12-08
Submitted:1994-12-21
Entered:1995-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Arthralgia, Encephalitis, Eye pain, Myelitis, Neuropathy, Pyrexia, Urinary tract infection, Visual disturbance

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Metamucil l tsp in 8 oz of water
Current Illness: unk
Preexisting Conditions: duodenal ulcer and hiatal hernia at age 16, esophagitis with deformed bulb, slightly bulging annulus at L4-5, gastroesophageal reflux , vertigo
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 894356006Z

Write-up: pt recvd vax;subsequently devel neurological impairment;

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