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This is VAERS ID 69658

Case Details

VAERS ID: 69658 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Alabama  
Vaccinated:1992-11-17
Onset:0000-00-00
Submitted: 1994-11-28
Entered: 1994-12-19
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4928235 / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Condition aggravated, Depression, Guillain-Barre syndrome, Hypersensitivity, Immune system disorder, Neuropathy, Paraesthesia, Paralysis
SMQs:, Angioedema (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: unk
Current Illness: unk
Preexisting Conditions: pt has a hx of hypertension & coronary artery disease;
Allergies:
Diagnostic Lab Data: LP-results unspecified;
CDC Split Type: 894342006S

Write-up: pt recvd 17NOV92 & pt exp a hypersensitivity react permanent injury to immune system, disorder in immune system, rheumatoid like condition, inflammatory condition; devel GBS assoc w/partial paralysis, polyneuropathy, numbness, facial weak


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