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This is VAERS ID 67766

Case Details

VAERS ID: 67766 (history)  
Form: Version 1.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:1993-09-28
Onset:1993-09-28
   Days after vaccination:0
Submitted: 1994-10-23
   Days after onset:390
Entered: 1994-10-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER 359909 / 1 - / -

Administered by: Other       Purchased by: Private
Symptoms: Brain oedema, Cerebral haemorrhage, Coma, Neuropathy, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 58 days
   Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: large volume of records available
CDC Split Type:

Write-up: p/recv vax, lost conscienceness, fell/hit head on tile floor; suffered severe brain swelling, severe closed head inj, cerebral hematoma w/multiple brain contusions, fx skull, perm optic nerve damage;coma x1mo, hosp x2mo, rehab x 8mo.


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