VAERS ID: |
26497 (history) |
Form: |
Version 1.0 |
Age: |
53.0 |
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: |
1990-11-05 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS |
01670P / 1 |
RA / IM |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
226928 / 1 |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Nausea,
Pyrexia,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
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: ~ ()~~~In patient 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. |