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This is VAERS ID 58359

Case Details

VAERS ID: 58359 (history)  
Form: Version 1.0  
Age: 42.0  
Sex: Male  
Location: Virginia  
Vaccinated:1993-10-04
Onset:1993-10-15
   Days after vaccination:11
Submitted: 1993-11-24
   Days after onset:40
Entered: 1993-12-22
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938167 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Myasthenic syndrome, Neoplasm malignant, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Non-haematological malignant tumours (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: DTIC, Velban, Zofran, Decadron, Ativan, Adriamycin, Bleomycin;
Current Illness:
Preexisting Conditions: Allergic to penicillin;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893335001J

Write-up: Pt recvd vax 4OCT93 & c/o numbness in feet; 29OCT93 had inc numbness & tingling in both feet, numbness was moving up both legs; dx polyneuropathy to r/o GBS;


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