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From the 2/14/2018 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 27204



Case Details

VAERS ID: 27204 (history)  
Form: Version 1.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:1990-10-30
Onset:1990-11-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1990-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLU-IMUNE) / LEDERLE LABORATORIES 287973 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Asthenia, Dysphagia, Dyspnoea, Guillain-Barre syndrome
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Demyelination (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 900211201

Write-up: Following vax 62 yo male c/o weakness & difficulty swallowing&talking came to ER-hospitalized for 8 days Developed quadriplegia & resp difficulty,15Nov resp arrest. preliminary DX was Guillian Barre Synd.Final DX: GBS & resp failure


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180214&IDNUMBER=27204

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