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This is VAERS ID 80078

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 80078
VAERS Form:
Age:25.2
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 / WYETH 4958126 / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: INFECT, MYELITIS, MYASTHENIA, CSF ABNORM, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': none

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 12/8/2009

VAERS ID: 80078 Before After
VAERS Form:
Age:25.2
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-20 1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1995-1996 INFLUENZA (SEASONAL) (FLUSHIELD 95-96) / WYETH WYETH PHARMACEUTICALS, INC 4958126 / - LA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal, INFECT, MYELITIS, MYASTHENIA, CSF ABNORM, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': none WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 8/31/2010

VAERS ID: 80078 Before After
VAERS Form:
Age:25.2
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD 95-96) INFLUENZA (SEASONAL) (FLUSHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4958126 / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 7/7/2013

VAERS ID: 80078 Before After
VAERS Form:
Age:25.2
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 2/14/2017

VAERS ID: 80078 Before After
VAERS Form:
Age:25.2 25.0
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 5/14/2017

VAERS ID: 80078 Before After
VAERS Form:
Age:25.0
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / - LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 9/14/2017

VAERS ID: 80078 Before After
VAERS Form:(blank) 1
Age:25.0
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / - UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 2/14/2018

VAERS ID: 80078 Before After
VAERS Form:1
Age:25.0
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 6/14/2018

VAERS ID: 80078 Before After
VAERS Form:1
Age:25.0
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 8/14/2018

VAERS ID: 80078 Before After
VAERS Form:1
Age:25.0
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 9/14/2018

VAERS ID: 80078 Before After
VAERS Form:1
Age:25.0
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 10/14/2018

VAERS ID: 80078 Before After
VAERS Form:1
Age:25.0
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 12/24/2020

VAERS ID: 80078 Before After
VAERS Form:1
Age:25.0
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 12/30/2020

VAERS ID: 80078 Before After
VAERS Form:1
Age:25.0
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 5/7/2021

VAERS ID: 80078 Before After
VAERS Form:1
Age:25.0
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;


Changed on 5/14/2021

VAERS ID: 80078 Before After
VAERS Form:1
Age:25.0
Sex:Male
Location:Washington
Vaccinated:1995-10-09
Onset:1995-10-17
Submitted:1995-11-03
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958126 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Immune system disorder, Infection, Myasthenic syndrome, Myelitis, Neuropathy, Paraesthesia, Paralysis, CSF test abnormal

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC''s in CSF;
CDC 'Split Type': WA951190

Write-up: pt recvd vax;HA,stiff neck,n;aseptic meningitis suspected;lower extremity weakness,urinary incontinence to severe paresis,numbness mid-chest;unable to move legs;weakness upper extremities;dx post infectious immune;myelopathy/radioculopathy;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=80078&WAYBACKHISTORY=ON


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