VAERS ID: |
26637 (history) |
Form: |
Version 1.0 |
Age: |
|
Sex: |
Male |
Location: |
Iowa |
Vaccinated: | 1990-09-27 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
1990-11-14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
- / UNK |
- / - |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
268982 / UNK |
- / - |
Administered by: Unknown Purchased by: Unknown Symptoms: Facial palsy,
Myalgia,
Neck pain SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hearing impairment (broad), Arthritis (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: Current Illness: Preexisting Conditions: Prior to onset of Bell''s Palsy, pt had been aware of some myalgia & just not feeling quite right, also experienced mild pain in the neck. Allergies:
Diagnostic Lab Data: CDC Split Type: 900190501
Write-up: Pt vaccinated with Pneumococcal/Influenza developed symptoms of Bell''s Palsy. Prior to onset of Bell''s Palsy, pt had myalgia, mild pain in the neck & generally not feeling quite right. |