VAERS ID: |
28359 (history) |
Form: |
Version 1.0 |
Age: |
47.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 1990-10-31 |
Onset: | 1990-12-10 |
Days after vaccination: | 40 |
Submitted: |
1991-02-15 |
Days after onset: | 67 |
Entered: |
1991-02-18 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908205 / 2 |
- / A |
Administered by: Private Purchased by: Private Symptoms: Asthenia,
Facial palsy,
Paraesthesia SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
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, 20 days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Prednisone, Lopressor, Lasix, Vasotec Current Illness: Preexisting Conditions: Lupus, hypertension Allergies: Diagnostic Lab Data: EMG-polyneuropathy, EEG-normal CDC Split Type:
Write-up: Numbness, tingling, face hands, feet. Paralysis, face. Weakness, upper & lower extremities |