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This is VAERS ID 27228

Case Details

VAERS ID: 27228 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:1990-11-27
Onset:1990-11-29
   Days after vaccination:2
Submitted: 1990-12-22
   Days after onset:23
Entered: 1990-12-28
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11019 / 1 RA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Amnesia, Arthralgia, Asthenia, Back pain, Headache, Malaise, Palpitations, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Arthritis (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: All tests negative - Cat Scan - thyroid hormone; Spinal fluid
CDC Split Type:

Write-up: Pt vaccinated w/FLU. Developed loss of memory for 2-3 hrs; headache; tired-listless (3 wks post flu shot); tingling extremities; slight occasional palpitations; joint, back & head aches of short duration. No treatment. Still not 100%.


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