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This is VAERS ID 58137

Case Details

VAERS ID: 58137 (history)  
Form: Version 1.0  
Age: 46.0  
Sex: Male  
Location: Maryland  
Vaccinated:1993-10-12
Onset:1993-10-14
   Days after vaccination:2
Submitted: 1993-12-07
   Days after onset:54
Entered: 1993-12-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41026 / UNK - / -

Administered by: Military       Purchased by: Military
Symptoms: Agitation, Anaemia, Asthenia, Confusional state, Encephalitis, Infection, Pyrexia, Stupor
SMQs:, Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: HIV pos
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO5166

Write-up: fever, confusion & agitation 2 days p/vax; picutre was consistent w/encephalitis by EEG & nl head CT/MRI;


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