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This is VAERS ID 40387

Case Details

VAERS ID: 40387 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Male  
Location: Maryland  
Vaccinated:1991-11-06
Onset:1991-11-06
   Days after vaccination:0
Submitted: 1991-11-20
   Days after onset:14
Entered: 1992-03-19
   Days after submission:120
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4918202 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Delirium, Dizziness, Hypokinesia, Vestibular disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: MD92016

Write-up: 6NOV91 4PM exp dizziness; 8PM dizzy-room spinning, unable to get OOB; vomiting; adm to hosp & remains hospitalized x 5 days; MD r/o middle ear disorder;


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