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This is VAERS ID 26866

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 26866 (history)  
Form: Version .0  
Age: 71.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:1990-10-23
Onset:1990-10-27
   Days after vaccination:4
Submitted: 1990-10-27
   Days after onset:0
Entered: 1990-11-30
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11226 / - LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Face oedema, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Given Seldane Anhydroxizine
CDC Split Type: MA900005

Write-up: Pt vaccinated with Influenza four days following injection, pt stated "I had red spots on my face", followed by a generalized facial rash on day five & swelling of the face on day six.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=26866


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