VAERS ID: |
26615 (history) |
Form: |
Version 1.0 |
Age: |
49.0 |
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: |
1990-11-13 |
Days after submission: | 8 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4908192 / UNK |
LA / IM |
Administered by: Other Purchased by: Private Symptoms: Herpes zoster,
Pruritus,
Pyrexia,
Rash SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (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: 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. |