| VAERS ID: |
59120 (history) |
| Form: |
Version 1.0 |
| Age: |
62.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 1993-11-28 |
| Onset: | 1993-12-11 |
| Days after vaccination: | 13 |
| Submitted: |
1993-12-21 |
| Days after onset: | 10 |
| Entered: |
1994-01-18 |
| Days after submission: | 28 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4938278 / UNK |
- / IM A |
Administered by: Other Purchased by: Private
Symptoms: Asthenia,
Cardiovascular disorder,
Dysphagia,
Dyspnoea,
Guillain-Barre syndrome,
Neck pain,
Neuropathy,
Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Demyelination (narrow), Arthritis (broad), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: hx of labile hypertension, uterine cancer--rx''d in 1975, hysterectomy, osteoporosis, acute herniated disc--rx''d w/epidural blocks; allergic to sulfa drugs & possibly Demerol;
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893357001J
Write-up: pt recvd flu vax 28NOV93 & approx 14DEC93 began to devel sx of GBS; remains hospitalized as the date of this report in stable condition; |
