| VAERS ID: |
92401 (history) |
| Form: |
Version 1.0 |
| Age: |
43.0 |
| Sex: |
Female |
| Location: |
South Carolina |
| Vaccinated: | 1996-11-14 |
| Onset: | 1996-11-15 |
| Days after vaccination: | 1 |
| Submitted: |
1996-11-21 |
| Days after onset: | 6 |
| Entered: |
1996-11-26 |
| Days after submission: | 5 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
E3096GB / UNK |
- / - |
Administered by: Other Purchased by: Other
Symptoms: Faecal incontinence,
Gastrointestinal disorder,
Myelitis,
Paraplegia,
Urinary incontinence
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Noninfectious diarrhoea (broad), Immune-mediated/autoimmune disorders (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: ~ ()~~~In patient
Other Medications: Adalat;Niacin
Current Illness: NONE
Preexisting Conditions: HTN, hyperlipidemia
Allergies:
Diagnostic Lab Data: MRI''s & LP completel nl;
CDC Split Type:
Write-up: transverse myelitis w/paraplegia, sensory loss to T3 & bowel;MRI head, C-spine, T-spine, L-S spine LP;pt transferred to nurse for tertiary care facility; |
