VAERS ID: |
107835 (history) |
Form: |
Version 1.0 |
Age: |
65.0 |
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 |
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. |
E3367HB / UNK |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Hypertonia,
Hypokinesia,
Myalgia,
Myasthenic syndrome,
Neuritis,
Neuropathy,
Pain SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Malignancy related conditions (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
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: ~ ()~~~In patient 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: MPI98158
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 |