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This is VAERS ID 39713

Case Details

VAERS ID: 39713 (history)  
Form: Version 1.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:1991-12-14
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1992-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Encephalitis, Encephalopathy, Movement disorder, Paraesthesia, Thinking abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Diabinese, Procardia XL, Tenormin, Capoten, Provachol, Aldactone, Lasix;
Current Illness:
Preexisting Conditions: Type II DM-incr chol, HTN, CHF;
Allergies:
Diagnostic Lab Data: EEG-?temporal lobe problem, MRI; lab eval none positive;
CDC Split Type:

Write-up: Pt devel encephalopathy thought to be encephalitis-unknown cause; (initially c/o numbness rt hand x 2 wks opposite arm from inject then deterioration of motor skills & mental status over 5 days;


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