| VAERS ID: |
92037 (history) |
| Form: |
Version 1.0 |
| Age: |
34.0 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 1996-11-01 |
| Onset: | 1996-11-11 |
| Days after vaccination: | 10 |
| Submitted: |
1996-11-12 |
| Days after onset: | 1 |
| Entered: |
1996-11-18 |
| Days after submission: | 6 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
00786P / 1 |
- / IM A |
Administered by: Private Purchased by: Other
Symptoms: Coordination abnormal,
Guillain-Barre syndrome,
Hypotonia,
Hypoxia,
Myasthenic syndrome,
Paraesthesia
SMQs:, Asthma/bronchospasm (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Malignancy related conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (narrow)
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? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Vanceril
Current Illness: NONE
Preexisting Conditions: history of asthma
Allergies:
Diagnostic Lab Data: NONE PROVIDED
CDC Split Type: 0010150960104
Write-up: pt recv vax & exp rt shoulder & upper arm numbness, loss of balance & weakness in legs on 11NOV96, 10 days p/vax pt went to MD & dx w/GBS;pt hosp on 11NOV96; |
