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This is VAERS ID 26865

(NOTE: This result is from the 2/14/2018 version of the VAERS database)

Case Details

VAERS ID: 26865 (history)  
Form: Version 1.0  
Age: 56.0  
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: 1990-11-30
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11216 / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Chills, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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: ~ ()~~~In patient
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: MA900004

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=20180214&IDNUMBER=26865


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