| VAERS ID: |
106323 (history) |
| Form: |
Version .0 |
| Age: |
44.6 |
| Sex: |
Male |
| Location: |
Ohio |
| Vaccinated: | 1997-11-02 |
| Onset: | 1997-11-06 |
| Days after vaccination: | 4 |
| Submitted: |
1998-01-07 |
| Days after onset: | 62 |
| Entered: |
1998-01-13 |
| Days after submission: | 6 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / - |
- / - |
Administered by: Other Purchased by: Other
Symptoms: Asthenia,
Guillain-Barre syndrome,
Hypoxia,
Paralysis
SMQs:, Asthma/bronchospasm (broad), Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Dilantin, decadron 9started in JUL post op brain surg)
Current Illness: glioblastoma
Preexisting Conditions: before dx glioblasma, excellent health before & ater;
Allergies:
Diagnostic Lab Data: several CT scans, MRI, blood work, etc;refused to test for GBS;
CDC Split Type:
Write-up: quadriplegia & 100% vent assisted;pt too weakened to cont w/chemotherapy;prognosis is less than 2mo; |
