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This is VAERS ID 89769

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 89769
VAERS Form:
Age:56.8
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA488A6 / - - / IM
IPV: POLIOVAX / CONNAUGHT LTD L1108 / - - / IM
TYP: VIVOTIF BERNA / SWISS SERUM 1402116 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: HYPOKINESIA, GUILLAIN BARRE SYND, GAIT ABNORM, LAB TEST ABNORM, BONE DIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 12/8/2009

VAERS ID: 89769 Before After
VAERS Form:
Age:56.8
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-11 1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA488A6 / - - / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. L1108 / - - / IM
TYP: VIVOTIF BERNA TYPHOID LIVE ORAL TY21A (VIVOTIF) / SWISS SERUM BERNA BIOTECH, LTD 1402116 / - - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation, HYPOKINESIA, GUILLAIN BARRE SYND, GAIT ABNORM, LAB TEST ABNORM, BONE DIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 2/14/2017

VAERS ID: 89769 Before After
VAERS Form:
Age:56.8 56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / - - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / - - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 1402116 / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 5/14/2017

VAERS ID: 89769 Before After
VAERS Form:
Age:56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / - - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / - - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 1402116 / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 9/14/2017

VAERS ID: 89769 Before After
VAERS Form:(blank) 1
Age:56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / - UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / - UNK - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 1402116 / - UNK - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 11/14/2017

VAERS ID: 89769 Before After
VAERS Form:1
Age:56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / UNK - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD BERNA BIOTECH, LTD. 1402116 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 2/14/2018

VAERS ID: 89769 Before After
VAERS Form:1
Age:56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / UNK - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 1402116 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 6/14/2018

VAERS ID: 89769 Before After
VAERS Form:1
Age:56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / UNK - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 1402116 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 8/14/2018

VAERS ID: 89769 Before After
VAERS Form:1
Age:56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / UNK - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 1402116 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 9/14/2018

VAERS ID: 89769 Before After
VAERS Form:1
Age:56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / UNK - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 1402116 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 10/14/2018

VAERS ID: 89769 Before After
VAERS Form:1
Age:56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / UNK - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 1402116 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 12/24/2020

VAERS ID: 89769 Before After
VAERS Form:1
Age:56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / UNK - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 1402116 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 12/30/2020

VAERS ID: 89769 Before After
VAERS Form:1
Age:56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / UNK - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 1402116 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 5/7/2021

VAERS ID: 89769 Before After
VAERS Form:1
Age:56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / UNK - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 1402116 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS


Changed on 5/21/2021

VAERS ID: 89769 Before After
VAERS Form:1
Age:56.0
Sex:Male
Location:North Carolina
Vaccinated:1996-05-01
Onset:1996-05-12
Submitted:1996-08-27
Entered:1996-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA488A6 / UNK - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / UNK - / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 1402116 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Bone disorder, Dermatitis bullous, Gait disturbance, Guillain-Barre syndrome, Hypokinesia, Laboratory test abnormal, Myasthenic syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gamma GLobulin by Armour lot# P9101 given 1MAY96;
Current Illness: NONE
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: CSF oligoclonal banding;EMG consistent w/GBS
CDC 'Split Type':

Write-up: 1MAY96 pt recv vax & devel blistered red spots on lt foot;12MAY96 diff carrying luggage & being slow-also having diff walking;to MD found multilevel degenerative spondylosis & herniated disc-did not improve w/surgery;EMG consistent w/GBS

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