VAERS ID: |
26940 (history) |
Form: |
Version 1.0 |
Age: |
77.0 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: | 1990-11-02 |
Onset: | 1990-11-03 |
Days after vaccination: | 1 |
Submitted: |
1990-11-30 |
Days after onset: | 27 |
Entered: |
1990-12-10 |
Days after submission: | 10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11222 / UNK |
LA / IM |
Administered by: Private Purchased by: Unknown Symptoms: Faecal incontinence,
Gait disturbance,
Pain,
Paraesthesia,
Urinary incontinence SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (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? Yes, 12 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Annual physical Preexisting Conditions: ASHD COPD Allergies: Diagnostic Lab Data: Neurology Consultation = post vaccination myelopathy CDC Split Type:
Write-up: Pt vaccinated with Influenza developed pain in lower extremities, numbness of lower abdomen, unstable gait, incontinence of bladder/bowel. |