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This is VAERS ID 104634

Case Details

VAERS ID: 104634 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Maine  
Vaccinated:1997-09-18
Onset:1997-10-14
   Days after vaccination:26
Submitted: 1997-11-11
   Days after onset:28
Entered: 1997-11-13
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81854 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Hyporeflexia, Muscle atrophy, Myasthenic syndrome, Paralysis
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO7737

Write-up: pt recv vax SEP97 & pt devel GBS 1mo p/vax;approx 14OCT97 pt exp rt leg weakness that progressed to profound rt leg weakness;sx persist as of the time of report 6NOV97;reportedly pt had no prior hx of GBS;


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