| 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), Immune-mediated/autoimmune disorders (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 |
