| VAERS ID: |
38114 (history) |
| Form: |
Version 1.0 |
| Age: |
67.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 1991-11-22 |
| Onset: | 1991-11-30 |
| Days after vaccination: | 8 |
| Submitted: |
1991-12-06 |
| Days after onset: | 6 |
| Entered: |
1991-12-23 |
| Days after submission: | 17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01481P / 1 |
- / IM |
Administered by: Private Purchased by: Unknown
Symptoms: CSF test abnormal,
Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (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, ? days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Trinsicon Q day
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Spinal fluid protein elvated to 115 mg%, Compatible w/ diagnosis
CDC Split Type:
Write-up: Guillian Barre Synd | 