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This is VAERS ID 100352

Case Details

VAERS ID: 100352 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:1994-09-29
Onset:1994-09-30
   Days after vaccination:1
Submitted: 1997-07-03
   Days after onset:1007
Entered: 1997-07-18
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 2 - / -

Administered by: Private       Purchased by: Other
Symptoms: Myelitis, Neuropathy, Paralysis
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: hx of non-insulin dependent diabetes mellitus, hypothyroidism, chronic back pain synd, prev flu vax 6NOV92;
Allergies:
Diagnostic Lab Data: 12OCT96 EMG
CDC Split Type: 010150970085001

Write-up: pt recv vax & exp transverse myelitis p''/vax;pt has not yet recovered, sx still persits;vax given 29SEP94;pt still exp transverse myelitis on 13OCT94;EMG performed on 12OCT96;3JUL97 related that became paralyzed p/vax;


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