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This is VAERS ID 63926

(NOTE: This result is from the 2/14/2018 version of the VAERS database)

Case Details

VAERS ID: 63926 (history)  
Form: Version 1.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:1989-10-30
Onset:1989-11-07
   Days after vaccination:8
Submitted: 1994-06-23
   Days after onset:1688
Entered: 1994-06-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp resp rxn @ 48 y/o w/flu dose #1;~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: pos titers: EBV AUG1991; cortisol level .41;
CDC Split Type:

Write-up: severe react lost 2 wks work-could not breathe; exp onset of stroke like weakness 8MAR90; dx CFS-dx EBV;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180214&IDNUMBER=63926


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