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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), Immune-mediated/autoimmune disorders (narrow)

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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