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This is VAERS ID 58132

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58132
VAERS Form:
Age:73.6
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938167 / 1 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND, ASTHENIA, MYASTHENIA, CSF ABNORM, DYSARTHRIA

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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type':

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 12/8/2009

VAERS ID: 58132 Before After
VAERS Form:
Age:73.6
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-14 1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH WYETH PHARMACEUTICALS, INC 4938167 / 1 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test abnormal, GUILLAIN BARRE SYND, ASTHENIA, MYASTHENIA, CSF ABNORM, DYSARTHRIA

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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': (blank) 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 8/31/2010

VAERS ID: 58132 Before After
VAERS Form:
Age:73.6
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) INFLUENZA (SEASONAL) (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4938167 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 7/7/2013

VAERS ID: 58132 Before After
VAERS Form:
Age:73.6
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 1 - / IM
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 12/14/2016

VAERS ID: 58132 Before After
VAERS Form:
Age:73.6
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 1 - / IM
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 2/14/2017

VAERS ID: 58132 Before After
VAERS Form:
Age:73.6 73.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 5/14/2017

VAERS ID: 58132 Before After
VAERS Form:
Age:73.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 9/14/2017

VAERS ID: 58132 Before After
VAERS Form:(blank) 1
Age:73.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 1 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 2/14/2018

VAERS ID: 58132 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 6/14/2018

VAERS ID: 58132 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 8/14/2018

VAERS ID: 58132 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 9/14/2018

VAERS ID: 58132 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 10/14/2018

VAERS ID: 58132 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 12/24/2020

VAERS ID: 58132 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

Changed on 12/30/2020

VAERS ID: 58132 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Virginia
Vaccinated:1993-10-08
Onset:1993-10-28
Submitted:1993-11-16
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dysarthria, Guillain-Barre syndrome, Hyporeflexia, Myasthenic syndrome, Myopathy, Neuropathy, CSF test 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: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT;
Current Illness: Large cell lymphoma of abdomen;
Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus;
Allergies:
Diagnostic Lab Data: CSF protein 155;
CDC 'Split Type': 893321001J

Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS;

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