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This is VAERS ID 29946

Case Details

VAERS ID: 29946 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Male  
Location: New Mexico  
Vaccinated:1990-10-01
Onset:1990-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Brain stem syndrome, Neuropathy
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (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, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Pt had flu shot 1 yr ago w/out problems
Allergies:
Diagnostic Lab Data: MRI & CT head scan - WNL; Sp Tap- no available
CDC Split Type: 904090006

Write-up: Brain stem disordr, cranial nerve palsies are rept''d in a pt rec''d Fluogen; Approx 1OCT90 rec''d vax 1 wk later developed cranial nerve palsies w/the concern of a poss demyelinating condition of the brain stem;


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