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This is VAERS ID 80107

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 80107
VAERS Form:
Age:58.6
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1995-1996 / PARKE-DAVIS 01285P / 0 A / -

Administered by: Private      Purchased by: Unknown
Symptoms: NEUROPATHY, GUILLAIN BARRE SYND, CSF ABNORM

Life Threatening? Yes
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? Yes
Previous Vaccinations:
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 12/8/2009

VAERS ID: 80107 Before After
VAERS Form:
Age:58.6
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-20 1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1995-1996 INFLUENZA (SEASONAL) (FLUOGEN 95-96) / PARKE-DAVIS 01285P / 0 A / -

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal, NEUROPATHY, GUILLAIN BARRE SYND, CSF ABNORM

Life Threatening? Yes
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? Yes
Previous Vaccinations:
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 8/31/2010

VAERS ID: 80107 Before After
VAERS Form:
Age:58.6
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 95-96) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 0 A / -

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations:
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 7/7/2013

VAERS ID: 80107 Before After
VAERS Form:
Age:58.6
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 0 A / -
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 0 A / -

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations:
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 2/14/2017

VAERS ID: 80107 Before After
VAERS Form:
Age:58.6 58.0
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 0 A / -

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations:
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 5/14/2017

VAERS ID: 80107 Before After
VAERS Form:
Age:58.0
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 0 A - / - A

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 9/14/2017

VAERS ID: 80107 Before After
VAERS Form:(blank) 1
Age:58.0
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 0 1 - / A

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 2/14/2018

VAERS ID: 80107 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 1 - / A

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 6/14/2018

VAERS ID: 80107 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 1 - / A

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 8/14/2018

VAERS ID: 80107 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 1 - / A

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 9/14/2018

VAERS ID: 80107 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 1 - / A

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 10/14/2018

VAERS ID: 80107 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 1 - / A

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 12/24/2020

VAERS ID: 80107 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 1 - / A

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 12/30/2020

VAERS ID: 80107 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 1 - / A

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 5/7/2021

VAERS ID: 80107 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 1 - / A

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;


Changed on 5/14/2021

VAERS ID: 80107 Before After
VAERS Form:1
Age:58.0
Sex:Female
Location:Maine
Vaccinated:1995-10-26
Onset:1995-11-03
Submitted:1995-11-29
Entered:1995-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01285P / 1 - / A

Administered by: Private      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, Neuropathy, CSF test abnormal

Life Threatening? Yes
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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: inc CSF protein; abnormal neuro condition;
CDC 'Split Type':

Write-up: pt recvd vax; devel GBS;

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