| VAERS ID: |
48049 (history) |
| Form: |
Version .0 |
| Age: |
84.6 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 1992-10-22 |
| Onset: | 1992-10-22 |
| Days after vaccination: | 0 |
| Submitted: |
1992-10-23 |
| Days after onset: | 1 |
| Entered: |
1992-12-14 |
| Days after submission: | 52 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4928241 / 5 |
LA / - |
Administered by: Public Purchased by: Public
Symptoms: Cerebral haemorrhage,
Paralysis,
Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic cerebrovascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad)
Life Threatening? Yes
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: NONE
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: dx: intracerebral hemorrhage; no evidence seen by MD of hypersensitivity rxn to vax;
CDC Split Type: BA92001
Write-up: loss of consciousness, paralysis; |
