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This is VAERS ID 69583

Case Details

VAERS ID: 69583 (history)  
Form: Version 1.0  
Age: 54.0  
Sex: Male  
Location: North Carolina  
Vaccinated:1994-10-31
Onset:1994-11-02
   Days after vaccination:2
Submitted: 1994-12-08
   Days after onset:36
Entered: 1994-12-14
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948110 / 1 - / -

Administered by: Other       Purchased by: Private
Symptoms: Erectile dysfunction, Libido decreased
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vasotec; Paxil
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: w/in 2 days p/shot sudden & immed drop in libido & sexual desire; difficulty maintaining erection; no problems prev to shot;


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