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This is VAERS ID 39772

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39772
VAERS Form:
Age:49.3
Sex:Male
Location:Georgia
Vaccinated:1992-01-16
Onset:1992-01-26
Submitted:1992-02-25
Entered:1992-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: IPV / CONNAUGHT LTD G01031 / - - / SC
MEN: MENOMUNE A/C/Y/W / CONNAUGHT LABS 1F31063 / - - / SC
TD: TD ADSORBED, ADULTS / CONNAUGHT LABS 1K31145 / - - / IM
TYP: VIVOTIF BERNA / SWISS SERUM 120602A / - - / PO
YF: YELLOW FEVER / CONNAUGHT LABS 1L21002 / - - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: HEADACHE, ASTHENIA, CSF ABNORM, DIPLOPIA

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC 'Split Type': hx of endocarditis 1986

Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia


Changed on 12/8/2009

VAERS ID: 39772 Before After
VAERS Form:
Age:49.3 49.0
Sex:Male
Location:Georgia
Vaccinated:1992-01-16
Onset:1992-01-26
Submitted:1992-02-25
Entered:1992-03-04 1992-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / CONNAUGHT LTD PASTEUR MERIEUX INST. G01031 / - - / SC
MEN: MENOMUNE A/C/Y/W MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1F31063 / - - / SC
TD: TD ADSORBED, ADULTS TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1K31145 / - - / IM
TYP: VIVOTIF BERNA TYPHOID LIVE ORAL TY21A (VIVOTIF) / SWISS SERUM BERNA BIOTECH, LTD 120602A / - - / PO
YF: YELLOW FEVER YELLOW FEVER (YF-VAX) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1L21002 / - - / SC

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Asthenia, Diplopia, Guillain-Barre syndrome, Headache, CSF test abnormal, HEADACHE, ASTHENIA, CSF ABNORM, DIPLOPIA

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC 'Split Type': hx of endocarditis 1986 (blank)

Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia


Changed on 1/5/2010

VAERS ID: 39772 Before After
VAERS Form:
Age:49.0
Sex:Male
Location:Georgia
Vaccinated:1992-01-16
Onset:1992-01-26
Submitted:1992-02-25
Entered:1992-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G01031 / - - UN / SC
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 1F31063 / - - UN / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K31145 / - - UN / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 120602A / - - / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / - - UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Diplopia, Guillain-Barre syndrome, Headache, CSF test abnormal

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC 'Split Type':

Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia


Changed on 6/14/2014

VAERS ID: 39772 Before After
VAERS Form:
Age:49.0
Sex:Male
Location:Georgia
Vaccinated:1992-01-16
Onset:1992-01-26
Submitted:1992-02-25
Entered:1992-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G01031 / - UN / SC
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 1F31063 / - UN / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K31145 / - UN / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 120602A / - - / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / - UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Diplopia, Guillain-Barre syndrome, Headache, CSF test abnormal

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC 'Split Type':

Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia


Changed on 5/14/2017

VAERS ID: 39772 Before After
VAERS Form:
Age:49.0
Sex:Male
Location:Georgia
Vaccinated:1992-01-16
Onset:1992-01-26
Submitted:1992-02-25
Entered:1992-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G01031 / - UN / SC
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 1F31063 / - UN / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K31145 / - UN / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 120602A / - - / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / - UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Diplopia, Guillain-Barre syndrome, Headache, CSF test abnormal

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC 'Split Type':

Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia


Changed on 9/14/2017

VAERS ID: 39772 Before After
VAERS Form:(blank) 1
Age:49.0
Sex:Male
Location:Georgia
Vaccinated:1992-01-16
Onset:1992-01-26
Submitted:1992-02-25
Entered:1992-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G01031 / - UNK UN / SC
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 1F31063 / - UNK UN / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K31145 / - UNK UN / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 120602A / - UNK - MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / - UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Diplopia, Guillain-Barre syndrome, Headache, CSF test abnormal

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC 'Split Type':

Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia


Changed on 11/14/2017

VAERS ID: 39772 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Georgia
Vaccinated:1992-01-16
Onset:1992-01-26
Submitted:1992-02-25
Entered:1992-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G01031 / UNK UN / SC
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 1F31063 / UNK UN / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K31145 / UNK UN / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD BERNA BIOTECH, LTD. 120602A / UNK MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Diplopia, Guillain-Barre syndrome, Headache, CSF test abnormal

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC 'Split Type':

Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia


Changed on 2/14/2018

VAERS ID: 39772 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Georgia
Vaccinated:1992-01-16
Onset:1992-01-26
Submitted:1992-02-25
Entered:1992-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G01031 / UNK UN / SC
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 1F31063 / UNK UN / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K31145 / UNK UN / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 120602A / UNK MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Diplopia, Guillain-Barre syndrome, Headache, CSF test abnormal

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC 'Split Type':

Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia


Changed on 6/14/2018

VAERS ID: 39772 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Georgia
Vaccinated:1992-01-16
Onset:1992-01-26
Submitted:1992-02-25
Entered:1992-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G01031 / UNK UN / SC
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 1F31063 / UNK UN / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K31145 / UNK UN / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 120602A / UNK MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Diplopia, Guillain-Barre syndrome, Headache, CSF test abnormal

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC 'Split Type':

Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia


Changed on 8/14/2018

VAERS ID: 39772 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Georgia
Vaccinated:1992-01-16
Onset:1992-01-26
Submitted:1992-02-25
Entered:1992-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G01031 / UNK UN / SC
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 1F31063 / UNK UN / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K31145 / UNK UN / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 120602A / UNK MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Diplopia, Guillain-Barre syndrome, Headache, CSF test abnormal

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC 'Split Type':

Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia


Changed on 9/14/2018

VAERS ID: 39772 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Georgia
Vaccinated:1992-01-16
Onset:1992-01-26
Submitted:1992-02-25
Entered:1992-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G01031 / UNK UN / SC
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 1F31063 / UNK UN / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K31145 / UNK UN / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 120602A / UNK MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Diplopia, Guillain-Barre syndrome, Headache, CSF test abnormal

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC 'Split Type':

Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia


Changed on 10/14/2018

VAERS ID: 39772 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Georgia
Vaccinated:1992-01-16
Onset:1992-01-26
Submitted:1992-02-25
Entered:1992-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G01031 / UNK UN / SC
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 1F31063 / UNK UN / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1K31145 / UNK UN / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 120602A / UNK MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 1L21002 / UNK UN / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asthenia, Diplopia, Guillain-Barre syndrome, Headache, CSF test abnormal

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Began Lariam (Mefloquine) on 26JAN92;
Current Illness: NONE
Preexisting Conditions: hx of endocarditis 1986
Allergies:
Diagnostic Lab Data: inc protein on spinal tap;
CDC 'Split Type':

Write-up: Following vax pt began to exp h/a; woke am of 27JAN92 w/severe h/a & diplopia; Seen by MD then went to hos for MRI, sp tap & lab work; 28JAN92 sx continued began having weakness; pt adm to hosp & given steroid therapy; cont to have diplopia

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