VAERS ID: |
26709 (history) |
Form: |
Version 1.0 |
Age: |
79.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 1990-11-01 |
Onset: | 1990-11-01 |
Days after vaccination: | 0 |
Submitted: |
1990-11-02 |
Days after onset: | 1 |
Entered: |
1990-11-21 |
Days after submission: | 19 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
11203 / UNK |
LA / - |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH |
285909 / 1 |
RA / - |
Administered by: Public Purchased by: Public Symptoms: Oedema,
Pain SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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: CA903
Write-up: Pt vaccinated Pnuemococcal/FLU rt arm now swollen, wrist to shoulder. No known allergies. |