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This is VAERS ID 25675

Case Details

VAERS ID: 25675 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Male  
Location: Maryland  
Vaccinated:1989-10-12
Onset:1989-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4898171 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Asthenia, Confusional state
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Pt has previously received Influenza vaccine every yr /w out rxn.~ ()~~~In patient
Other Medications: Prednisone, K-Lor, Lasix, Feledene, Bronkosol, NSS Nebulizer, Alupent Inhaler, Zaroxolyn
Current Illness:
Preexisting Conditions: Pt has hx of connective tissue disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type: 890211001B

Write-up: Pt received Influenza vaccine when awoke on the day after was in a semi-conscious state, grossly confused & weak; unable to recognize his wife or his doctor. This reaction has been previously reported to USP.


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