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This is VAERS ID 26125

Case Details

VAERS ID: 26125 (history)  
Form: Version 1.0  
Age: 88.0  
Sex: Male  
Location: Ohio  
Vaccinated:1990-09-21
Onset:1990-09-22
   Days after vaccination:1
Submitted: 1990-09-24
   Days after onset:2
Entered: 1990-09-28
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11208 / UNK RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Quinidex, Theodur, Lasix, Isordil, Lanoxin
Current Illness:
Preexisting Conditions: Coron Art. Dis., COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated w/fluzone 21SEP90 on 24SEP90 pt granddght called ofc stating pt had been resting on Saturday & woke up with bilat leg numbenss that lasted 2 hrs then vanished. Pt up & walking with walker there after.


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