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This is VAERS ID 80967

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 80967
VAERS Form:
Age:52.6
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH - / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: MYELITIS, MYASTHENIA, HYPOTHERMIA, HYPERTENS, INCONTIN URIN

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: 27     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type':

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 12/8/2009

VAERS ID: 80967 Before After
VAERS Form:
Age:52.6
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-24 1996-01-22
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: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence, MYELITIS, MYASTHENIA, HYPOTHERMIA, HYPERTENS, INCONTIN URIN

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: 27     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': (blank) 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 8/31/2010

VAERS ID: 80967 Before After
VAERS Form:
Age:52.6
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
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: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 7/7/2013

VAERS ID: 80967 Before After
VAERS Form:
Age:52.6
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
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: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 12/14/2016

VAERS ID: 80967 Before After
VAERS Form:
Age:52.6
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
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: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 2/14/2017

VAERS ID: 80967 Before After
VAERS Form:
Age:52.6 52.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 5/14/2017

VAERS ID: 80967 Before After
VAERS Form:
Age:52.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 9/14/2017

VAERS ID: 80967 Before After
VAERS Form:(blank) 1
Age:52.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / - UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 2/14/2018

VAERS ID: 80967 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 6/14/2018

VAERS ID: 80967 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 8/14/2018

VAERS ID: 80967 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 9/14/2018

VAERS ID: 80967 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 10/14/2018

VAERS ID: 80967 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 12/24/2020

VAERS ID: 80967 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 12/30/2020

VAERS ID: 80967 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 5/7/2021

VAERS ID: 80967 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia


Changed on 5/14/2021

VAERS ID: 80967 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Pennsylvania
Vaccinated:1993-11-18
Onset:1993-11-27
Submitted:1995-12-21
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Hypertension, Hypothermia, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Paralysis, Urinary incontinence

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: 27     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tenormin tablets
Current Illness: unk
Preexisting Conditions: pt suffered a broken neck & required cervical fusion 20yrs prior to ADE;also had a hx of HTN, hyperglycemia & palpitations
Allergies:
Diagnostic Lab Data: x-ray c-spine fusion at c3-4 & c4-5 (old); MRI c-spine small disc herniation at c6-7;MRI thoracic spine small asymmetric bulging disc T10-11;MRI-lumbar spine unremarkable; Thoraco-lumb myelogram asymmetric bulging disc T10-11 w/moderate bon
CDC 'Split Type': 896004001L

Write-up: pt recvd vax 18NOV93 & 27NOV93 7AM pt exp numbness & tingling sensation in both arms;weakness progressed throughout the day & hardly able to move extremities;gen weakness-stinging sensation;HTN BP 197/123;urinary incontinence;paresthesia

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