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This is VAERS ID 29811

Case Details

VAERS ID: 29811 (history)  
Form: Version 1.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:1990-10-19
Onset:1990-10-20
   Days after vaccination:1
Submitted: 1991-03-08
   Days after onset:139
Entered: 1991-04-08
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908200 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Influenza, Myasthenic syndrome, Neoplasm malignant, Neuropathy, Neuropathy peripheral, Pain, Pyrexia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: UKN
Current Illness:
Preexisting Conditions: pt has hx of malignant tumor of uterus, tx w/chemoterapy; Current MRIs show no recurrence of tumor or metastases;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891078001B

Write-up: Neuropathy peripheral; pt developed flu-like sx w/in 24 hrs of receiving vax; third day, low grade fever developed which has persisted to date; Also aches, pain & weakness in her rt arm, & peripheral neuritis-dx branchial plexus neuropathy;


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