This is VAERS ID 31177

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Arthritis, Back pain
SMQs:, Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Arthritis (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness:
Preexisting Conditions: allergic to: nalfom, feldene, penicillin;
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES90110197

Write-up: Pt given 1st dose of vax DEC86, 2nd dose of vax JAN87; in approx MAR87 exp arthritis in lt hip, lt knee, rt hip & back; tx Nalfon, Feldene & Motrin; Rec''d 3rd dose of vax JUN87, as of 30OCT90 episodes of hip, knee & back pain persisted;