This is VAERS ID 28340

Case Details

VAERS ID:	28340 (history)
Form:	Version 1.0
Age:	58.0
Sex:	Male
Location:	North Carolina

Vaccinated:	1990-11-09
Onset:	1990-11-20
Days after vaccination:	11
Submitted:	1991-02-14
Days after onset:	86
Entered:	1991-02-18
Days after submission:	4

Vaccination / Manufacturer	Lot / Dose	Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS	PD02680P / UNK	LA / IM

Administered by: Other Purchased by: Public
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paralysis
SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Information from hosp. has not yet been received.
CDC Split Type:

Write-up: 20Nov90 pt developing back pain /w radiation down legs, weakness & some paralysis developed. Was evaluated @ Hosp. DX of Guillian Barre made Dec90. Was allowed to return to full duty @ work 4Feb91

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