This is VAERS ID 26614

(NOTE: This result is from the 8/31/2010 version of the VAERS database)

Case Details

VAERS ID:	26614 (history)
Form:	Version .0
Age:	44.1
Sex:	Female
Location:	Michigan

Vaccinated:	1990-11-01
Onset:	1990-11-01
Days after vaccination:	0
Submitted:	1990-11-03
Days after onset:	2
Entered:	1990-11-13
Days after submission:	10

Vaccination / Manufacturer	Lot / Dose	Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH	4908509 / -	LA / IM

Administered by: Other Purchased by: Other
Symptoms: Injection site mass, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (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:
Other Medications: Ogen
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Influenza Vaccine became itchy in area lt arm; hard in area; sl swollen, red & warm started evening 1NOV90 has continued stated less red & swollen today 3NOV90.

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100831&IDNUMBER=26614