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This is VAERS ID 38114

Case Details

VAERS ID: 38114 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: Ohio  
Vaccinated:1991-11-22
Onset:1991-11-30
   Days after vaccination:8
Submitted: 1991-12-06
   Days after onset:6
Entered: 1991-12-23
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01481P / 1 - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: CSF test abnormal, Guillain-Barre syndrome
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? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC Split Type:

Write-up: Guillian Barre Synd


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