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This is VAERS ID 413664

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/4/2011

VAERS ID: 413664
VAERS Form:
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLULAVAL 10-11) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / - LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 4/13/2011

VAERS ID: 413664 Before After
VAERS Form:
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLULAVAL 10-11) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / - LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Chronic obstructive pulmonary disease, Condition aggravated, Death, Guillain-Barre syndrome, Hypoaesthesia, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 5/13/2011

VAERS ID: 413664 Before After
VAERS Form:
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLULAVAL 10-11) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / - LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Chronic obstructive pulmonary disease, Condition aggravated, Death, Guillain-Barre syndrome, Hypoaesthesia, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 7/12/2011

VAERS ID: 413664 Before After
VAERS Form:
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / - LA / UN
FLU(10-11): INFLUENZA (SEASONAL) (FLULAVAL 10-11) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / - LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 7/7/2013

VAERS ID: 413664 Before After
VAERS Form:
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / - LA / UN
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / - LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 9/14/2017

VAERS ID: 413664 Before After
VAERS Form:(blank) 1
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / - UNK LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 2/14/2018

VAERS ID: 413664 Before After
VAERS Form:1
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / UNK LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 6/14/2018

VAERS ID: 413664 Before After
VAERS Form:1
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / UNK LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 8/14/2018

VAERS ID: 413664 Before After
VAERS Form:1
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / UNK LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 9/14/2018

VAERS ID: 413664 Before After
VAERS Form:1
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / UNK LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 10/14/2018

VAERS ID: 413664 Before After
VAERS Form:1
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / UNK LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 12/24/2020

VAERS ID: 413664 Before After
VAERS Form:1
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / UNK LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 12/30/2020

VAERS ID: 413664 Before After
VAERS Form:1
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / UNK LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 5/7/2021

VAERS ID: 413664 Before After
VAERS Form:1
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / UNK LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.


Changed on 5/21/2021

VAERS ID: 413664 Before After
VAERS Form:1
Age:88.0
Sex:Male
Location:Rhode Island
Vaccinated:2010-11-03
Onset:2010-11-17
Submitted:2010-12-28
Entered:2010-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA622AA / UNK LA / UN

Administered by: Public      Purchased by: Other
Symptoms: Asthenia, Cerebrovascular accident, Death, Hypoaesthesia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-12-02
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE NOTED
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No record available.
CDC 'Split Type':

Write-up: After 2 weeks SP immunization Resid - Began to c/o increased weakness & numbness. Sat -$g MD. Apt with MD. Started on neurontin 11/20. Sat on floor. L/T increased weakness. 11/21 -$g hosp with signs & sx of CVA.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=413664&WAYBACKHISTORY=ON


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