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This is VAERS ID 37809

Case Details

VAERS ID: 37809 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Nevada  
Vaccinated:1991-10-07
Onset:1991-10-13
   Days after vaccination:6
Submitted: 1991-12-02
   Days after onset:50
Entered: 1991-12-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1J21107 / UNK - / IM

Administered by: Other       Purchased by: Public
Symptoms: Guillain-Barre syndrome, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

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, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: assume well @ time of vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4030

Write-up: Pt recvd flu vax 7OCT91 & began falling & devel leg numbness 15OCT91 & was admitted to the hosp dx w/GBS; MD felt rxn was unrelated to flu vax;


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