| 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)
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 |
