VAERS ID: |
58132 (history) |
Form: |
Version .0 |
Age: |
73.6 |
Sex: |
Male |
Location: |
Virginia |
Vaccinated: | 1993-10-08 |
Onset: | 1993-10-28 |
Days after vaccination: | 20 |
Submitted: |
1993-11-16 |
Days after onset: | 19 |
Entered: |
1993-12-14 |
Days after submission: | 28 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU: INFLUENZA VACCINE 1993-1994 / WYETH |
4938167 / 1 |
- / IM |
Administered by: Other Purchased by: Unknown Symptoms: ASTHENIA,
CSF ABNORM,
DYSARTHRIA,
GUILLAIN BARRE SYND,
MYASTHENIA SMQs:
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? Yes
Previous Vaccinations: Other Medications: VINCRISTINE, HYTRIN, HYDROCHLOROTHIAZIDE, PRILOSEC, MICRONASE, NORVASC, ISOSORBIDE DINITRATE, CYTOXAN, NOVANTRONE, NITROGLYCERIN OINTMENT; Current Illness: Large cell lymphoma of abdomen; Preexisting Conditions: Severe atherosclerotic cardiovascular disease, s/p coronary artery bypass graft, MIs, & large cell lymphoma of abdomen; non-insulin dependent diabetes mellitus; Allergies: Diagnostic Lab Data: CSF protein 155; CDC Split Type:
Write-up: Dx in SEP93 w/large cell lymphoma of abdomen; recvd 3 courses of chemotherapy; 08OCT93 recvd vax; 28OCT93 exp weakness & skeletal pain; fell several times; admitted to hosp 29OCT93, dx of rule out GBS; |