| VAERS ID: |
43894 (history) |
| Form: |
Version 1.0 |
| Age: |
62.0 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 1988-11-25 |
| Onset: | 1988-12-10 |
| Days after vaccination: | 15 |
| Submitted: |
1991-01-04 |
| Days after onset: | 755 |
| Entered: |
1991-09-03 |
| Days after submission: | 241 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / IM |
Administered by: Other Purchased by: Other
Symptoms: Asthenia,
Back pain,
CSF test abnormal,
Electrocardiogram abnormal,
Guillain-Barre syndrome,
Hypertension,
Hyporeflexia,
Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (narrow), Hypertension (narrow), Cardiomyopathy (broad), Demyelination (narrow), 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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Orudis Capsules
Current Illness: NONE
Preexisting Conditions: pt has known allergy to PCN; inc cholesterol in the past; pos for diabetes mellitus in mom & dad; father also had emphysema;
Allergies:
Diagnostic Lab Data: Spinal fluid analysis-inc spinal fluid protein, nl glucose & w/o leukocytes; Cholesterol 319; Triglycerides 276; EMG & Nerve conduction velocities showed mltifocal conduction abn;
CDC Split Type: B073089012
Write-up: Pt recvd flu vax & was admitted to hosp w/extremity weakness & numbness; approx 4-5 days prior to admission, pt had dorsal & epigastric pain assoc w/tingling in hands & feet;poss GBS; also areflexia; BP 190/100; |
