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: |
1990-08-13 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 89-90) / WYETH PHARMACEUTICALS, INC |
4898171 / - |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Asthenia,
Confusional state SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
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: 890211001B
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. |