| VAERS ID: |
30242 (history) |
| Form: |
Version 1.0 |
| Age: |
47.0 |
| Sex: |
Female |
| Location: |
Colorado |
| Vaccinated: | 1990-10-26 |
| Onset: | 1990-11-06 |
| Days after vaccination: | 11 |
| Submitted: |
1991-04-05 |
| Days after onset: | 150 |
| Entered: |
1991-04-29 |
| Days after submission: | 23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908181 / 1 |
- / A |
Administered by: Private Purchased by: Private
Symptoms: Abscess,
Central nervous system neoplasm,
Cerebral infarction,
Cerebrovascular accident,
Multiple sclerosis,
Neuropathy,
Speech disorder,
Thinking abnormal
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (broad), Demyelination (narrow), Non-haematological tumours of unspecified malignancy (narrow), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 46 days
Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI-lesion on lt side of brain, biopsy-inconclusive results r/o a glimona & multiple sclerosis.
CDC Split Type: 891099001B
Write-up: Pt experienced severe vomiting & cold sx approx 1 wk /p receiving vax on 9NOV90; Developed severe speaking difficulties 4mo later & was hospitalized; MRI revealed a lesion on the lt side of brain; dx w/demyelinating encephalopathy; |
