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This is VAERS ID 43894

(NOTE: This result is from the 8/14/2018 version of the VAERS database)

Case Details

VAERS ID: 43894 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Male  
Location: New York  
   Days after vaccination:15
Submitted: 1991-01-04
   Days after onset:755
Entered: 1991-09-03
   Days after submission:241
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Back pain, CSF test abnormal, Electrocardiogram abnormal, Guillain-Barre syndrome, Hypertension, Hyporeflexia, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (narrow), Hypertension (narrow), Cardiomyopathy (broad), Demyelination (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Orudis Capsules
Current Illness: NONE
Preexisting Conditions: pt has known allergy to PCN; inc cholesterol in the past; pos for diabetes mellitus in mom & dad; father also had emphysema;
Diagnostic Lab Data: Spinal fluid analysis-inc spinal fluid protein, nl glucose & w/o leukocytes; Cholesterol 319; Triglycerides 276; EMG & Nerve conduction velocities showed mltifocal conduction abn;
CDC Split Type: B073089012

Write-up: Pt recvd flu vax & was admitted to hosp w/extremity weakness & numbness; approx 4-5 days prior to admission, pt had dorsal & epigastric pain assoc w/tingling in hands & feet;poss GBS; also areflexia; BP 190/100;

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