| VAERS ID: |
77516 (history) |
| Form: |
Version 1.0 |
| Age: |
65.0 |
| Sex: |
Female |
| Location: |
Hawaii |
| Vaccinated: | 1995-06-05 |
| Onset: | 1995-07-18 |
| Days after vaccination: | 43 |
| Submitted: |
1995-09-15 |
| Days after onset: | 59 |
| Entered: |
1995-09-19 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
VHA440A6 / 1 |
- / IM |
| IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. |
K0227 / UNK |
- / SC |
| PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
0536A / UNK |
- / SC |
| TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES |
51371053 / UNK |
- / IM |
| TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
MO / PO |
Administered by: Military Purchased by: Military
Symptoms: CSF test abnormal,
Guillain-Barre syndrome,
Hypokinesia,
Hypotonia,
Laryngospasm,
Movement disorder
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 55 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: bipolar disorder
Allergies:
Diagnostic Lab Data: CSF protein 90%, no cells
CDC Split Type:
Write-up: 20JUL devel acute severe GBS; presently on ventilator day 55, no motor activity; in hosp 21JUL to present; |
