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This is VAERS ID 37846

Case Details

VAERS ID: 37846 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Arizona  
Vaccinated:1991-10-18
Onset:1991-11-14
   Days after vaccination:27
Submitted: 1991-12-03
   Days after onset:19
Entered: 1991-12-09
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21209 / 1 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Procardia, Ascriptin
Current Illness: NONE
Preexisting Conditions: previous hx brainstomy tia w/flaccid FEB91
Allergies:
Diagnostic Lab Data: MRI Scan-neg; LP-normal; NCV loss of F waves, slowing;
CDC Split Type:

Write-up: 3 wks post inject pt devel paralysis;


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