| VAERS ID: |
26703 (history) |
| Form: |
Version 1.0 |
| Age: |
25.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 1990-10-31 |
| Onset: | 1990-11-02 |
| Days after vaccination: | 2 |
| Submitted: |
1990-11-06 |
| Days after onset: | 4 |
| Entered: |
1990-11-21 |
| Days after submission: | 15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11221 / 1 |
- / A |
Administered by: Private Purchased by: Other
Symptoms: Asthenia,
Diarrhoea,
Influenza,
Nausea,
Pyrexia,
Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
CDC Split Type:
Write-up: Pt vaccinated with Influenza vaccine developed diarrhea, flu-like symptoms, rash, fatigue, nausea, fever. |
