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This is VAERS ID 36344

Case Details

VAERS ID: 36344 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Male  
Location: Texas  
Vaccinated:1991-10-28
Onset:1991-10-28
   Days after vaccination:0
Submitted: 1991-10-28
   Days after onset:0
Entered: 1991-11-14
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Confusional state, Hypertension, Speech disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hypoglycaemia (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: Pt had similar rxn @ 40 w/Influenza;~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891304014J

Write-up: Pt exp mental confusion, slurring of speech, hypertension, & vomiting immediately p/vax; treated in ER w/meds; Seem to be improving but MD had pt admitted to hosp for continued observation;


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