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This is VAERS ID 25675

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 25675 (history)  
Form: Version .0  
Age: 62.0  
Sex: Male  
Location: Maryland  
Vaccinated:1989-10-12
Onset:1989-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1989-1990 TRIVALENT TYPES A&B / WYETH 4898171 / - - / -

Administered by: Private       Purchased by: Unknown
Symptoms: ASTHENIA, CONFUS
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Pt has previously received Influenza vaccine every yr /w out rxn.
Other Medications: Prednisone, K-Lor, Lasix, Feledene, Bronkosol, NSS Nebulizer, Alupent Inhaler, Zaroxolyn
Current Illness:
Preexisting Conditions: Pt has hx of connective tissue disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type: Pt has hx of connective tissue disorder

Write-up: Pt received Influenza vaccine when awoke on the day after was in a semi-conscious state, grossly confused & weak; unable to recognize his wife or his doctor. This reaction has been previously reported to USP.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=25675


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