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This is VAERS ID 27816

Case Details

VAERS ID: 27816 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Male  
Location: Florida  
Vaccinated:1990-10-30
Onset:1990-11-12
   Days after vaccination:13
Submitted: 1991-01-28
   Days after onset:77
Entered: 1991-02-08
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287973 / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Muscle atrophy, Paralysis, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: neck & back sprain (auto accident)
Allergies:
Diagnostic Lab Data: See hospital records; See treating physicians.
CDC Split Type:

Write-up: Fever, respiratory paralysis, etc. Admitted for about 2 wks. Under care of neurologists including automatic respirator.


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