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This is VAERS ID 64504

Case Details

VAERS ID: 64504 (history)  
Form: Version 1.0  
Age: 67.0  
Sex: Female  
Location: Tennessee  
Vaccinated:1993-10-11
Onset:1993-11-06
   Days after vaccination:26
Submitted: 1994-06-09
   Days after onset:214
Entered: 1994-07-07
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / PFIZER/WYETH 361923 / 2 - / A

Administered by: Private       Purchased by: Other
Symptoms: Muscle atrophy, Myasthenic syndrome, Myelitis, Neuropathy, Pain, Quadriplegia
SMQs:, Peripheral neuropathy (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: none;~ ()~~~In patient
Other Medications: procardia xl / premarin; dyazide / motrin;
Current Illness: none;
Preexisting Conditions: hypertension; arthritis;
Allergies:
Diagnostic Lab Data: MRI of c spine: results not provided;
CDC Split Type: 940120401

Write-up: pt recvd vax; pt devel paresis of all four extremities; dx: transverse myelitis;


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