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This is VAERS ID 36763

Case Details

VAERS ID: 36763 (history)  
Form: Version 1.0  
Age: 54.0  
Sex: Male  
Location: Colorado  
Vaccinated:1991-10-30
Onset:1991-11-04
   Days after vaccination:5
Submitted: 1991-11-21
   Days after onset:17
Entered: 1991-12-03
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918146 / UNK - / IM A

Administered by: Other       Purchased by: Private
Symptoms: Asthenia, Hypokinesia, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)

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, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hypercholesterol POD, hx of hiatis hernia & rheumatic fever;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO9193

Write-up: Pt recvd vax 30OCT91, started devel pain/tingling in hands & feet approx 1 wk p/vax; progressive weakness.Pt fell X2. Bilateral & symetrical weakness; primarly affected extremities never intubated; dec EMG''s; plasmapheresis;


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