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This is VAERS ID 35525

Case Details

VAERS ID: 35525 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Illinois  
Vaccinated:1990-12-04
Onset:1990-12-19
   Days after vaccination:15
Submitted: 1991-06-11
   Days after onset:173
Entered: 1991-10-16
   Days after submission:127
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908195 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Guillain-Barre syndrome, Paralysis
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: unk
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: 891198011B

Write-up: Pt devel GBS w/paralysis approx 3 wks p/receiving influenza vax; pt believes the vax caused this problem;


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