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This is VAERS ID 55955

Case Details

VAERS ID: 55955 (history)  
Form: Version 1.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:1990-10-23
Onset:1990-11-03
   Days after vaccination:11
Submitted: 1992-10-28
   Days after onset:725
Entered: 1993-09-08
   Days after submission:314
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Delirium, Encephalitis, Visual disturbance
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 920357801

Write-up: plaintiff alleges that as a result of vax 23OCT90, pt was hospitalized on 3NOV90 w/dx of post vaccination focal encephalitis @ time of litigation OCT92; reportedly has permanent brain damage w/severe vision problems;


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