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This is VAERS ID 39455

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39455
VAERS Form:
Age:70.0
Sex:Unknown
Location:Michigan
Vaccinated:1991-12-14
Onset:1991-12-14
Submitted:0000-00-00
Entered:1992-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1991-1992 / CONNAUGHT LABS 1F21218 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: HYPOKINESIA, ENCEPHALITIS, PARESTHESIA, THINKING ABNORM

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


Changed on 12/8/2009

VAERS ID: 39455 Before After
VAERS Form:
Age:70.0
Sex:Unknown
Location:Michigan
Vaccinated:1991-12-14
Onset:1991-12-14
Submitted:0000-00-00
Entered:1992-02-17 1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1991-1992 INFLUENZA (SEASONAL) (FLUZONE 91-92) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1F21218 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal, HYPOKINESIA, ENCEPHALITIS, PARESTHESIA, THINKING ABNORM

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


Changed on 8/31/2010

VAERS ID: 39455 Before After
VAERS Form:
Age:70.0
Sex:Unknown
Location:Michigan
Vaccinated:1991-12-14
Onset:1991-12-14
Submitted:0000-00-00
Entered:1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 91-92) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


Changed on 7/7/2013

VAERS ID: 39455 Before After
VAERS Form:
Age:70.0
Sex:Unknown
Location:Michigan
Vaccinated:1991-12-14
Onset:1991-12-14
Submitted:0000-00-00
Entered:1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


Changed on 5/14/2017

VAERS ID: 39455 Before After
VAERS Form:
Age:70.0
Sex:Unknown
Location:Michigan
Vaccinated:1991-12-14
Onset:1991-12-14
Submitted:0000-00-00
Entered:1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


Changed on 9/14/2017

VAERS ID: 39455 Before After
VAERS Form:(blank) 1
Age:70.0
Sex:Unknown
Location:Michigan
Vaccinated:1991-12-14
Onset:1991-12-14
Submitted:0000-00-00
Entered:1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


Changed on 2/14/2018

VAERS ID: 39455 Before After
VAERS Form:1
Age:70.0
Sex:Unknown
Location:Michigan
Vaccinated:1991-12-14
Onset:1991-12-14
Submitted:0000-00-00
Entered:1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


Changed on 6/14/2018

VAERS ID: 39455 Before After
VAERS Form:1
Age:70.0
Sex:Unknown
Location:Michigan
Vaccinated:1991-12-14
Onset:1991-12-14
Submitted:0000-00-00
Entered:1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


Changed on 8/14/2018

VAERS ID: 39455 Before After
VAERS Form:1
Age:70.0
Sex:Unknown
Location:Michigan
Vaccinated:1991-12-14
Onset:1991-12-14
Submitted:0000-00-00
Entered:1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


Changed on 9/14/2018

VAERS ID: 39455 Before After
VAERS Form:1
Age:70.0
Sex:Unknown
Location:Michigan
Vaccinated:1991-12-14
Onset:1991-12-14
Submitted:0000-00-00
Entered:1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


Changed on 10/14/2018

VAERS ID: 39455 Before After
VAERS Form:1
Age:70.0
Sex:Unknown
Location:Michigan
Vaccinated:1991-12-14
Onset:1991-12-14
Submitted:0000-00-00
Entered:1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=39455&WAYBACKHISTORY=ON


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