| 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: |
1993-12-13 |
| Days after submission: | 27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 93-94) / WYETH PHARMACEUTICALS, INC |
4938167 / 1 |
- / IM |
Administered by: Other Purchased by: Other
Symptoms: Asthenia,
CSF test abnormal,
Dysarthria,
Guillain-Barre syndrome,
Hyporeflexia,
Myasthenic syndrome,
Myopathy,
Neuropathy
SMQs:, Rhabdomyolysis/myopathy (narrow), Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
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: 893321001J
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; |
