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This is VAERS ID 36454

Case Details

VAERS ID: 36454 (history)  
Form: Version 1.0  
Age: 60.0  
Sex: Male  
Location: West Virginia  
Vaccinated:1991-10-01
Onset:1991-10-01
   Days after vaccination:0
Submitted: 1991-11-11
   Days after onset:41
Entered: 1991-11-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01471P / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Blood creatine phosphokinase increased, Hemiplegia, Malaise, Myopathy
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CPK=20,000
CDC Split Type: 914091019

Write-up: Transient hemiparesis, rhabdomyolysis, myoclobinuria, elevated CPK reported in pt receiving FLuogen; pt exp weakness, fatigue, malaise w/o feve & transient hemiparesis; pt hospitalized w/dx rhabdomyolysis & myoglobinuria;


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