| VAERS ID: |
58132 (history) |
| Form: |
Version 1.0 |
| Age: |
73.0 |
| 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 |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4938167 / 2 |
- / 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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: ~ ()~~~In patient
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; |
