| VAERS ID: |
26803 (history) |
| Form: |
Version .0 |
| Age: |
79.8 |
| Sex: |
Male |
| Location: |
Massachusetts |
| Vaccinated: | 1990-11-01 |
| Onset: | 1990-11-02 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
1990-11-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
0F11224 / - |
RA / SC |
Administered by: Public Purchased by: Public
Symptoms: Atrial flutter,
Cough,
Myalgia,
Pericarditis,
Pneumonia,
Pyrexia,
Right ventricular failure
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Pulmonary hypertension (narrow), Eosinophilic pneumonia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Isordil, Cardizem, Kerlone
Current Illness:
Preexisting Conditions: HBP, coronary ischemia
Allergies:
Diagnostic Lab Data: CSR & CBC - normal 6NOV90
CDC Split Type:
Write-up: Pt vaccinated with Influenza experienced low grade fever, cough, sx persist & atrial flutter fib, admitted to hosp w/pneumonia, CHF. |
