VAERS ID: |
35526 (history) |
Form: |
Version 1.0 |
Age: |
55.0 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: | 1990-11-09 |
Onset: | 1990-11-24 |
Days after vaccination: | 15 |
Submitted: |
1991-06-07 |
Days after onset: | 194 |
Entered: |
1991-10-16 |
Days after submission: | 131 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908194 / UNK |
- / - |
Administered by: Other Purchased by: Other Symptoms: Asthenia,
Guillain-Barre syndrome,
Hypertension,
Paraesthesia SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (narrow), Hypertension (narrow), Demyelination (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Pt recvd Hep B vax on 28SEP90 & 29OCT90; Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: A review of the batch record for lot# 4908194 was satisfactory w/no anomalies noted; CDC Split Type: 890354001B
Write-up: Pt devel GBS p/receiving influenza vax; sx included numbness & tingling in hands, feet, & lt side of face; weakness in limbs; & elevation in BP; pt hospitalized on 24NOV90 & treated w/meds; |