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This is VAERS ID 106308

Case Details

VAERS ID: 106308 (history)  
Form: Version 1.0  
Age: 83.0  
Sex: Male  
Location: Mississippi  
Vaccinated:1997-10-20
Onset:0000-00-00
Submitted: 1997-12-03
Entered: 1998-01-12
   Days after submission:40
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E20037KA / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Adrenal insufficiency, Asthenia, Coordination abnormal, Guillain-Barre syndrome, Hypertonia, Myasthenic syndrome, Neuropathy, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Hypoglycaemia (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: grip strength 80-85%;thininning of muscle bulk to first dorsal interosseous muscle;thyroid nl;CPK nl;sed rate 50;total white count 7,800 w/H&H 12.9 & 39.1;rheumatoid factor neg;EKG nonspecific ST changes plus LAD:
CDC Split Type: MS97056

Write-up: pt exp worsening weakness x 2mo w/diff walking x2wk;pt exp joint stiffness;devel some numbness in hands & feet;pt noted to have flipped T waves in lateral chest leads;pt hosp;muscle weakness;GBS, ataxic;control dec;polyradiculoneuropathy;


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