National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 12/8/2009 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 104867



Case Details

VAERS ID: 104867 (history)  
Form: Version .0  
Age: 38.0  
Sex: Male  
Location: Missouri  
Vaccinated:1997-10-27
Onset:1997-10-27
   Days after vaccination:0
Submitted: 1997-11-02
   Days after onset:6
Entered: 1997-11-19
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 97-98) / CONNAUGHT LABORATORIES 7F81755 / - - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (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:
Other Medications: Pneumovax;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 28OCT97 EMG;spinal tap;nl sed rate, ANA, CPR, RA;CBC, chem 23, B12 level;
CDC Split Type:

Write-up: Guillain-Barre synd;


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=104867

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166