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This is VAERS ID 27097

Case Details

VAERS ID: 27097 (history)  
Form: Version 1.0  
Age: 80.0  
Sex: Female  
Location: Alabama  
Vaccinated:1990-11-16
Onset:1990-11-29
   Days after vaccination:13
Submitted: 1990-12-14
   Days after onset:15
Entered: 1990-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01870P / 1 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Calan, Niacin, Maxzide
Current Illness:
Preexisting Conditions: hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: Nerve conduction studies consistent /w Guilliain Barre on 13Dec90
CDC Split Type:

Write-up: Guillian Barre Synd, onset of myalgia about 2 wks /p vax, increased weakness of extremities, legs $g arms & in legs prox? distal musculature. Hospitalized 11Dec90


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