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This is VAERS ID 61058

Case Details

VAERS ID: 61058 (history)  
Form: Version 1.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:1992-10-12
Onset:1992-11-12
   Days after vaccination:31
Submitted: 1994-03-09
   Days after onset:482
Entered: 1994-03-28
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 337916 / 1 - / A

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac failure, Neck pain, Neuropathy, Nuchal rigidity, Peroneal nerve palsy, Pruritus, Speech disorder
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Dementia (broad), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, 14MAY93; EMG log #93-463;
CDC Split Type:

Write-up: approx 1 month p/flu vax, painful stiff neck, pain lt leg, lt foot drop; neurological tests indicated neuro disease; spinal tap hos dx A-myotrophic lateral sceloris (ALS); JUL93 lt side nerve degeneration & speech affected; also devel itch


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