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From the 12/8/2009 release of VAERS data (an older release, current is 1/15/2021):

This is VAERS ID 26600

Case Details

VAERS ID: 26600 (history)  
Form: Version .0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:1990-10-09
Onset:1990-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME, 90-91) / WYETH PHARMACEUTICALS, INC - / - - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow)

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:
Other Medications: Diazepam; Biscodyl, Demerol
Current Illness:
Preexisting Conditions: Spastic & dystomiquadraplegia, Cerebral palsy
Allergies:
Diagnostic Lab Data: CBC
CDC Split Type:

Write-up: Pt vaccinated with Influenza Vaccine developed hives over entire body, low grade fever.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=26600


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