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This is VAERS ID 39015

Case Details

VAERS ID: 39015 (history)  
Form: Version 1.0  
Age: 85.0  
Sex: Female  
Location: Illinois  
Vaccinated:1991-11-14
Onset:1991-12-14
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 1992-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / UNK - / IM A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Myasthenic syndrome, Speech disorder
SMQs:, Dementia (broad), Malignancy related conditions (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Immune-mediated/autoimmune 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: EC ASA, NTG patch, Lasix, K-DUR, Ditropan,Tolinase, Cardizem, Hydergine
Current Illness:
Preexisting Conditions: no allergies; post hx of CVA,DMASHD, HTN
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Approx 1 mo p/recvd flu vax, pt devel rt sided weakness w/inappropriate speech on 14DEC91; on 16DEC91 speech became appropriate but rt sided weakness continues w/rt hand weakness;


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