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This is VAERS ID 26865

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 26865 (history)  
Form: Version .0  
Age: 56.3  
Sex: Female  
Location: Massachusetts  
Vaccinated:1990-10-24
Onset:1990-10-24
   Days after vaccination:0
Submitted: 1990-11-26
   Days after onset:33
Entered: 1990-12-05
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11216 / 0 RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: CHILLS, HEADACHE, MYALGIA
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix, Meorol, Vasotec, Trendate, Lithium, Clonipin, Synthyroid, Coumadin.
Current Illness: Lupus, HTN, Depression
Preexisting Conditions: HTN, Hypothyroid, Depression, Angina
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Influenza approx 1 hr later developed severe chills, headache & muscle aches lasting two days.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=26865


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