VAERS ID: |
91916 (history) |
Form: |
Version 1.0 |
Age: |
57.0 |
Sex: |
Female |
Location: |
Missouri |
Vaccinated: | 1993-10-01 |
Onset: | 1993-11-01 |
Days after vaccination: | 31 |
Submitted: |
1996-11-06 |
Days after onset: | 1101 |
Entered: |
1996-11-13 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Extensor plantar response,
Multiple sclerosis,
Neuropathy SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: MRI & LP CDC Split Type:
Write-up: neurological sx-3wk p/vax lasted 3-4months-later dx w/multiple sclerosis @ age 57-no prior hx;no subsequent similar event in last 3yr; |