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This is VAERS ID 26504

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 26504 (history)  
Form: Version 1.0  
Age: 66.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1990-09-26
Onset:1990-10-14
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 1990-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01770P / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cough, Ear pain, Headache, Pharyngitis, Sinusitis
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Physical Exam only
CDC Split Type:

Write-up: Pt vaccinated with FLUOGEN developed sore throat, headache, earache, sinus drainage thru 22OCT90. Cough, congestion chest appt w/ Dr. Given antibiotic & expectorant by MD dx URI. "Symptoms not due to influenza injection."


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=26504


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