VAERS ID: |
108781 (history) |
Form: |
Version 1.0 |
Age: |
48.0 |
Sex: |
Male |
Location: |
Virginia |
Vaccinated: | 1997-10-16 |
Onset: | 1997-12-30 |
Days after vaccination: | 75 |
Submitted: |
1998-02-15 |
Days after onset: | 47 |
Entered: |
1998-03-23 |
Days after submission: | 36 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Guillain-Barre syndrome,
Pleural disorder,
Pneumonia SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: pt recv vax 16OCT97 & dx w/GBS on 30DEC97 to 17FEB98;prior to GBS dx in good health;no med problems;NKDA;started w/course of ATB on 22DEC97 for pneumonia P pleurisy; |