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From the 4/13/2011 release of VAERS data (an older release, current is 11/12/2021):

This is VAERS ID 413868

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Case Details

VAERS ID: 413868 (history)  
Form: Version .0  
Age: 70.0  
Sex: Male  
Location: New York  
Vaccinated:2010-07-09
Onset:0000-00-00
Submitted: 2010-12-28
Entered: 2011-01-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB711AA / 0 LA / IM
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 0695Z / 0 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Abasia, Abdominal pain, Abdominal wound dehiscence, Back pain, Bacteraemia, CSF protein increased, CSF white blood cell count increased, Chest tube insertion, Colectomy, Colostomy, Constipation, Coronary arterial stent insertion, Coronary artery occlusion, Death, Electrocardiogram ST segment elevation, Escherichia infection, Facial paresis, Fall, Foreign travel, Gait disturbance, Gastritis erosive, Gastrointestinal haemorrhage, Gastrointestinal tube insertion, Guillain-Barre syndrome, Hypoaesthesia, Immunoglobulin therapy, Intra-aortic balloon placement, Mechanical ventilation, Megacolon, Muscular weakness, Myocardial infarction, Pain in extremity, Peroneal nerve palsy, Pneumatosis intestinalis, Pneumonia, Pneumothorax, Renal failure acute, Sepsis, Thrombocytopenia, Tracheostomy, Wound evisceration
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (broad), Agranulocytosis (broad), Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal ulceration (narrow), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-12-11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Au at hospital. Not available to me.
CDC Split Type:

Write-up: GUILLAIN BARRE Syndrome Dx 10/2010 by Dr. Tx at hospital.


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