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This is VAERS ID 36164

Case Details

VAERS ID: 36164 (history)  
Form: Version 1.0  
Age: 68.0  
Sex: Female  
Location: Georgia  
Vaccinated:1991-10-07
Onset:1991-10-08
   Days after vaccination:1
Submitted: 1991-10-08
   Days after onset:0
Entered: 1991-11-08
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 498145 / 1 LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 308911 / 1 RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Asthenia
SMQs:, Guillain-Barre syndrome (broad)

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: ~ ()~~~In patient
Other Medications: Tegretol ?BP meds
Current Illness: NONE
Preexisting Conditions: Hx of brain tumor, szs & hypertension;
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA91294

Write-up: PC from Med ctr; admitted via ER @ 11AM w/ c/o feeling weak; has past hx of brain tumor, sz & hypertension on Tegretol & BP meds; no sz activity noted toady;


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