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This is VAERS ID 105296

Case Details

VAERS ID: 105296 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:1997-10-21
Onset:1997-11-01
   Days after vaccination:11
Submitted: 1997-11-24
   Days after onset:23
Entered: 1997-12-02
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / UNK LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Asthenia, CSF test abnormal, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-21
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Atenolol
Current Illness: HTn
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 1NOV CT scan head nl;ESR 20;WBC 8.8;CSF glucose 65;protein 78;WBC 0;C&S negative;
CDC Split Type:

Write-up: pt devel extreme weakness, Guillain Barre type sx, requiring adm to hosp 1NOV97;slow improvement w/gamma globulin administration;tx to rehab 19NOV;


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