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This is VAERS ID 27543

(NOTE: This result is from the 5/14/2017 version of the VAERS database)

Case Details

VAERS ID: 27543 (history)  
Form: Version .0  
Age: 85.0  
Sex: Male  
Location: Georgia  
Vaccinated:1990-11-19
Onset:1990-11-19
   Days after vaccination:0
Submitted: 1990-11-21
   Days after onset:2
Entered: 1991-01-25
   Days after submission:65
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 06580P / - LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Gait disturbance, Hyperhidrosis, Hypoglycaemia, Tremor
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (narrow)

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, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Procardia, Micronase, Ativan
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: Blood Sugar Test - 21
CDC Split Type: GA9025

Write-up: Pt vaccinated w/FLU developed difficulty walking out to the car, BP & Pulse normal. Felt clammy & blood sugar was 21. Also difficulty getting 1/2 cup coke swallowed was shaking & moaning,took to Hosp treated & observed in ER,admit for 1 day


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