VAERS ID: |
31337 (history) |
Form: |
Version 1.0 |
Age: |
22.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 1986-12-18 |
Onset: | 1986-12-19 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
1991-04-03 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
- / 1 |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Hypoaesthesia,
Visual field defect SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Optic nerve disorders (broad), Retinal 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? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: TRIPHASIL Current Illness: Allergies to Bactrim,Metamucil & soaps. Preexisting Conditions: Asthma synd.,all. to Macrodantin,Penicillin. Allergies: Diagnostic Lab Data: none CDC Split Type: WAES90090847
Write-up: pt. recvd 1st dose of hepatitis B vac & exp. loss of peripheral vision,& numbness on the rt side of face & rt arm. |