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This is VAERS ID 39455

(NOTE: This result is from the 8/31/2010 version of the VAERS database)

Case Details

VAERS ID: 39455 (history)  
Form: Version .0  
Age: 70.0  
Sex: Unknown  
Location: Michigan  
Vaccinated:1991-12-14
Onset:1991-12-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1992-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 1F21218 / - - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis, Hypokinesia, Paraesthesia, Thinking abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4122

Write-up: Encephalitis; As of 11FEB92 no reports on lot # 1F21218 have been reported;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100831&IDNUMBER=39455


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