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This is VAERS ID 482371

Case Details

VAERS ID: 482371 (history)  
Form: Version 1.0  
Age: 65.0  
Sex: Male  
Location: Virginia  
Vaccinated:2012-10-24
Onset:0000-00-00
Submitted: 2013-01-24
Entered: 2013-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1206101W / 3 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Aphasia, Asthenia, Chest pain, Death, Gait disturbance, Guillain-Barre syndrome, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic kidney diseas, hypertension, gout
Allergies:
Diagnostic Lab Data:
CDC Split Type: VA13002

Write-up: Hospitalized 12/12/12 through 12/22/12 at medical center. Complaints of 6 months'' increasing edema in hands and feet, current unsteady gait, decreased strength. Diagnosed with Guillain-Barre Syndrome. Readmit 1/3/13 with worsening weakness, dysphasia. 1/5/13, expired during transport by ambulance. Stopped at community hospital while en route. DOA at community hospital. Medical center reporting seen at another medical center prior to current medical center 1/3/13 admission for chest pain. Ruled out MI at that time.


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