| VAERS ID: |
48724 (history) |
| Form: |
Version 1.0 |
| Age: |
65.0 |
| Sex: |
Male |
| Location: |
Arizona |
| Vaccinated: | 1992-10-19 |
| Onset: | 1992-10-19 |
| Days after vaccination: | 0 |
| Submitted: |
1992-12-02 |
| Days after onset: | 44 |
| Entered: |
1993-01-07 |
| Days after submission: | 36 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4928228 / UNK |
LA / IM |
Administered by: Private Purchased by: Other
Symptoms: Coordination abnormal,
Guillain-Barre syndrome,
Hypokinesia,
Muscle atrophy,
Myalgia,
Neuritis,
Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: none specified;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMG, nerve conduction velocities, MRI of brain; (specific results unknown);
CDC Split Type: 892339002E
Write-up: pt recvd flu vax; pt states inject was given directly into ax nerve; pt exp instant severe pain that has persisted over 8 wks; atrophy of the posterior deltoid & impaired function & persistent pain in the lt deltoid & trapezius; poss GBS; |
