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This is VAERS ID 28077

Case Details

VAERS ID: 28077 (history)  
Form: Version 1.0  
Age: 72.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1990-10-16
Onset:1990-10-31
   Days after vaccination:15
Submitted: 1991-02-07
   Days after onset:99
Entered: 1991-02-12
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0J11164 / UNK - / -

Administered by: Military       Purchased by: Other
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow)

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, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Diabanase
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3771

Write-up: Possible GBS. While on vacation developed back pain, numbness & weakness in leg. Hospitalized. Currently undergoing physiotherapy.


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