VAERS ID: |
46497 (history) |
Form: |
Version 1.0 |
Age: |
83.0 |
Sex: |
Male |
Location: |
Hawaii |
Vaccinated: | 1991-11-13 |
Onset: | 1991-11-13 |
Days after vaccination: | 0 |
Submitted: |
1992-07-10 |
Days after onset: | 239 |
Entered: |
1992-10-26 |
Days after submission: | 108 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
148P / UNK |
- / - |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
314914 / UNK |
- / - |
Administered by: Public Purchased by: Public Symptoms: Hypokinesia,
Myalgia SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)
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? No
Previous Vaccinations: NONE~ ()~~~In patient Other Medications: Feldene Current Illness: NONE Preexisting Conditions: brucitis rt arm, back (surgery x 3) injury, arthritis; Allergies: Diagnostic Lab Data: NONE CDC Split Type: HI9209
Write-up: aching in lt arm since vax recvd, difficulty using arm; still aches everyday cannot raise arms to reach for things up high; hx of brucitis in rt arm, arthritis & bad back (surgery 3 times); |