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This is VAERS ID 57650

Case Details

VAERS ID: 57650 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Male  
Location: New York  
Vaccinated:1993-10-25
Onset:1993-10-26
   Days after vaccination:1
Submitted: 1993-11-18
   Days after onset:23
Entered: 1993-11-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3F41124 / 1 LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Amblyopia, Ear pain, Encephalopathy, Facial palsy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Optic nerve disorders (broad), Hearing impairment (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood test indicated no lyme disease present;
CDC Split Type:

Write-up: encephalopathy VII cranial nerve complete; paralysis of lt side of face-stabbing pain lt ear; vision blur; bell''s palsy;


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