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This is VAERS ID 63218

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 63218 (history)  
Form: Version .0  
Age: 81.7  
Sex: Male  
Location: Montana  
   Days after vaccination:24
Submitted: 1994-05-24
   Days after onset:203
Entered: 1994-06-08
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1993-1994 / WYETH 4938145 / - - / -

Administered by: Other       Purchased by: Unknown

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? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: unk
Other Medications:
Current Illness: parkinson
Preexisting Conditions: intestinal pseudo-obstruction
Diagnostic Lab Data: nerve conduction, spinal fluid eval;
CDC Split Type: intestinal pseudo-obstruction

Write-up: polyneuropathy p/influenza vax;

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