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From the 12/31/2003 release of VAERS data (an older release, current is 4/1/2021):

This is VAERS ID 107835

Case Details

VAERS ID: 107835 (history)  
Form: Version .0  
Age: 65.2  
Sex: Male  
Location: Ohio  
Vaccinated:1997-09-01
Onset:1997-10-01
   Days after vaccination:30
Submitted: 1998-02-25
   Days after onset:147
Entered: 1998-02-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUVIRIN 1997-1998 / MEDEVA PHARMS LI E3367HB / - - / IM

Administered by: Other       Purchased by: Unknown
Symptoms: HYPERTONIA, HYPOKINESIA, MYALGIA, MYASTHENIA, NEURITIS
SMQs:

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? No
Previous Vaccinations:
Other Medications: Fiorinal/Butalbital, USP;SYmmetrel/Amantadine
Current Illness:
Preexisting Conditions: Carpal Tunnel synd;carcinoma in porstate;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt recv vax & devel muscle soreness & stiffness 1mo post vax;pt devel muscle pain & weakness of upper & lower extremities;pt finds it hard to get up out of chair & suffers from bilat shoulder pain;devel acute neuritis w/brachial plexiopathy


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