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This is VAERS ID 57470

Case Details

VAERS ID: 57470 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:1993-10-01
Onset:1993-10-17
   Days after vaccination:16
Submitted: 1993-11-10
   Days after onset:24
Entered: 1993-11-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00963P / UNK - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Myelitis, Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 25 days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: lung fibrosis/COPD
Preexisting Conditions: lung fibrosis/COPD
Allergies:
Diagnostic Lab Data: extensive-none convlusive;
CDC Split Type:

Write-up: poss transverse myelitis w/paralysis from chest down;


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