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This is VAERS ID 28416

Case Details

VAERS ID: 28416 (history)  
Form: Version 1.0  
Age: 76.0  
Sex: Male  
Location: Georgia  
Vaccinated:1991-01-02
Onset:1991-01-28
   Days after vaccination:26
Submitted: 1991-01-28
   Days after onset:0
Entered: 1991-02-25
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 3 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), 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, 7 days
   Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: Cardezem
Current Illness: none
Preexisting Conditions: Coronary-artery disease; had CABG 1986-hx mild emphysema
Allergies:
Diagnostic Lab Data: 4Feb19 lumbar spine CT-revealed mild bulging disc, Refused myelogram, CT Head 2Feb91-probably normal, question RE: Rt sylvania fissure
CDC Split Type: GA9115

Write-up: C/O of progressive weakness in arms & legs since vax 2Jan91, getting worse 28Jan91-resulting in MD visit, Hospitalized 1Feb91, Dx: Guillain Barre Disease


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