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This is VAERS ID 92037

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 92037
VAERS Form:
Age:34.8
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1996-1997 / PARKE-DAVIS 00786P / 0 A / IM

Administered by: Private      Purchased by: Unknown
Symptoms: HYPOTONIA, GUILLAIN BARRE SYND, MYASTHENIA, ATAXIA, HYPOXIA

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:
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type':

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 12/8/2009

VAERS ID: 92037 Before After
VAERS Form:
Age:34.8
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-20 1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1996-1997 INFLUENZA (SEASONAL) (FLUOGEN 96-97) / PARKE-DAVIS 00786P / 0 A / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia, HYPOTONIA, GUILLAIN BARRE SYND, MYASTHENIA, ATAXIA, HYPOXIA

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:
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': (blank) 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 8/31/2010

VAERS ID: 92037 Before After
VAERS Form:
Age:34.8
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 96-97) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 0 A / IM

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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:
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 7/7/2013

VAERS ID: 92037 Before After
VAERS Form:
Age:34.8
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 0 A / IM
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 0 A / IM

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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:
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 2/14/2017

VAERS ID: 92037 Before After
VAERS Form:
Age:34.8 34.0
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 0 A / IM

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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:
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 5/14/2017

VAERS ID: 92037 Before After
VAERS Form:
Age:34.0
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 0 A - / IM IM A

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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: ~ ()~~~In patient
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 9/14/2017

VAERS ID: 92037 Before After
VAERS Form:(blank) 1
Age:34.0
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 0 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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: ~ ()~~~In patient
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 2/14/2018

VAERS ID: 92037 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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: ~ ()~~~In patient
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 6/14/2018

VAERS ID: 92037 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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: ~ ()~~~In patient
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 8/14/2018

VAERS ID: 92037 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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: ~ ()~~~In patient
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 9/14/2018

VAERS ID: 92037 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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: ~ ()~~~In patient
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 10/14/2018

VAERS ID: 92037 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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: ~ ()~~~In patient
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 12/24/2020

VAERS ID: 92037 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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: ~ ()~~~In patient
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 12/30/2020

VAERS ID: 92037 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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: ~ ()~~~In patient
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 5/7/2021

VAERS ID: 92037 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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: ~ ()~~~In patient
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

Changed on 5/14/2021

VAERS ID: 92037 Before After
VAERS Form:1
Age:34.0
Sex:Male
Location:New York
Vaccinated:1996-11-01
Onset:1996-11-11
Submitted:1996-11-12
Entered:1996-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00786P / 1 - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Coordination abnormal, Guillain-Barre syndrome, Hypotonia, Hypoxia, Myasthenic syndrome, Paraesthesia

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: ~ ()~~~In patient
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC 'Split Type': 0010150960104

Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=92037&WAYBACKHISTORY=ON


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