VAERS ID: |
107916 (history) |
Form: |
Version 1.0 |
Age: |
50.0 |
Sex: |
Male |
Location: |
Montana |
Vaccinated: | 0000-00-00 |
Onset: | 1997-10-01 |
Submitted: |
1998-02-13 |
Days after onset: | 135 |
Entered: |
1998-03-04 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Arthralgia,
Neuropathy SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Arthritis (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: Current Illness: Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: EMG, blood tests CDC Split Type:
Write-up: neuropathy, arthralgias p/vax; |