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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 26615

Case Details

VAERS ID: 26615 (history)  
Form: Version .0  
Age: 49.6  
Sex: Male  
Location: Ohio  
Vaccinated:1990-10-25
Onset:1990-11-01
   Days after vaccination:7
Submitted: 1990-11-05
   Days after onset:4
Entered: 1990-11-14
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA VACCINE 1990-1991 TYPES A&B WYETH / WYETH 4908192 / - LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: FEVER, HERPES ZOSTER, PRURITUS, RASH
SMQs:

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: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


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