VAERS ID: |
26703 (history) |
Form: |
Version .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 |
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11221 / 0 |
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)
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: 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. |