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From the 12/31/2003 release of VAERS data (an older release, current is 1/7/2021):

This is VAERS ID 26497

Case Details

VAERS ID: 26497 (history)  
Form: Version .0  
Age: 53.4  
Sex: Female  
Location: Florida  
Vaccinated:1990-10-25
Onset:1990-10-25
   Days after vaccination:0
Submitted: 1990-10-29
   Days after onset:4
Entered: 1990-11-12
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1989-1990 / PARKE-DAVIS 01670P / 0 RA / IM
PPV: PNU-IMUNE(R)23 / LEDERLE 226928 / 0 RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: FEVER, NAUSEA, VOMIT
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Influenza/PNU-IMUNE approx 1 hr following administration of vaccine pt developed nausea, vomiting, fever lasting approx 12 hrs.


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