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This is VAERS ID 37917

Case Details

VAERS ID: 37917 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Male  
Location: Maryland  
Vaccinated:1991-09-03
Onset:1991-09-19
   Days after vaccination:16
Submitted: 1991-09-19
   Days after onset:0
Entered: 1991-12-16
   Days after submission:88
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4818127 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Condition aggravated, Deafness, Vertigo, Vestibular disorder
SMQs:, Hearing impairment (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Salutensin, Theodur, Ventolin, Azmacort, Xanax;
Current Illness: NONE
Preexisting Conditions: pt has hx of hearing loss (wears 2 hearing aids), dizziness, hypertension, chronic obstructive pulmonary disease, & benign prostatic;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 891291023L

Write-up: Pt w/a long-standing hx of severe hearing impairment, claimed exp inc hearing loss 16 days p/recvd flu vax; On 24SEP91 pt c/o vertigo & poss Meniere''s disease;


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