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This is VAERS ID 172391

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 172391
VAERS Form:
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUVIRIN 00-01) / MEDEVA PHARMS LI E68780KA / - - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: ASTHENIA, COUGH INC, PARALYSIS, DYSPHAGIA, DYSARTHRIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type':

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2"002 from ALS, unassociated with flu vaccine.


Changed on 12/8/2009

VAERS ID: 172391 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-27 2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUVIRIN 00-01) INFLUENZA (SEASONAL) (FLUVIRIN 00-01) / MEDEVA PHARMS LI MEDEVA PHARMA, LTD. E68780KA / - - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis, ASTHENIA, COUGH INC, PARALYSIS, DYSPHAGIA, DYSARTHRIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': (blank) PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2"002 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "


Changed on 8/31/2010

VAERS ID: 172391 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN 00-01) INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / - - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "


Changed on 7/7/2013

VAERS ID: 172391 Before After
VAERS Form:
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / - - / IM
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / - - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "


Changed on 9/14/2017

VAERS ID: 172391 Before After
VAERS Form:(blank) 1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / - UNK - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "


Changed on 2/14/2018

VAERS ID: 172391 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / UNK - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "


Changed on 6/14/2018

VAERS ID: 172391 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / UNK - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "


Changed on 8/14/2018

VAERS ID: 172391 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / UNK - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "


Changed on 9/14/2018

VAERS ID: 172391 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / UNK - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "


Changed on 10/14/2018

VAERS ID: 172391 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / UNK - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "


Changed on 12/24/2020

VAERS ID: 172391 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / UNK - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "


Changed on 12/30/2020

VAERS ID: 172391 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / UNK - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "


Changed on 5/7/2021

VAERS ID: 172391 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / UNK - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "


Changed on 5/14/2021

VAERS ID: 172391 Before After
VAERS Form:1
Age:69.0
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-06
Onset:2000-10-20
Submitted:2001-05-14
Entered:2001-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E68780KA / UNK - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Cough, Dysarthria, Dysphagia, Paresis, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-03-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI - neg, Lyme - neg, EMG w/tensilon test - neg
CDC 'Split Type': PA0147

Write-up: Two weeks following immunizations with flu vaccine developed cough, coryza, weakness over the course of week developed dysarthia, dysphagia with cranial nerve paresis on exam. Diagnosed with ALS. According to 213289, 60 day follow up, patient died 03/20/2002 from ALS, unassociated with flu vaccine. Follow up on 09/18/2001: "The patients right arm was prepped and draped in a sterile fashion. 1% Xylocaine was employed for local anesthesia. A hand injection of contrast through a peripheral angiocath provided opacification of the deep veins of the right arm. The right basilic vein was accessed under fluoroscopic guidance with a micropuncture set. A cook PICC catheter was then trimmed to a length of 36cm and advanced through a peel-away sheath into the SVC. A hand injection of contrast through the catheter reveals the tip in the superior vena cava. The catheter was flushed and sutured in place. The catheter was then heparinized with 400 units Heparin and the patient was returned to the post-operative lounge in stable condition. "

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