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This is VAERS ID 26862

Case Details

VAERS ID: 26862 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1990-11-08
Onset:1990-11-08
   Days after vaccination:0
Submitted: 1990-11-26
   Days after onset:18
Entered: 1990-11-30
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11223 / 5 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Malaise, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Doxepin HCL, Hytrin, Dipyradimole
Current Illness:
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: MA900001

Write-up: Pt vac w/ flu vac developed weakness and mild numbness in torso lasting seven days. Denies difficulty breathing has not had prior reactions to Flu vaccine. 14Feb91: Neurologist comment," insufficient evidence to relate sx to flu shot".


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