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This is VAERS ID 33096

Case Details

VAERS ID: 33096 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:1990-10-18
Onset:1990-11-12
   Days after vaccination:25
Submitted: 1991-02-21
   Days after onset:101
Entered: 1991-10-15
   Days after submission:235
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908209 / 2 - / IM A

Administered by: Other       Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia, Paraesthesia
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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Pt exp weakness & numbness @ 67 y/o w/Influenza;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pt has chronic allergies to dust, grasses, & hx of severe allergy to horse serum discovered @ age 7;
Allergies:
Diagnostic Lab Data: 14DEC90 EMG-slight weakness 4.75/5 in the iliopsoas & hip extensors bilaterally; absence ofdeep tendon reflexes in upper & lower extremities; 14DEC90 Nerve conduction studies-prolonged peroneal conduction velocity; f-wave latencies;
CDC Split Type: 890354002B

Write-up: Approx 3 to 4 wks p/receiving Influenza vax, pt devel weakness in quadriceps muscles, w/difficulty climbing stairs & rising from a sitting posiiton, & numbness of feet; dx acquired sensorimotor polyneuropathy, demyelinating type, re-GBS;


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