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This is VAERS ID 26896

(NOTE: This result is from the 8/14/2018 version of the VAERS database)

Case Details

VAERS ID: 26896 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 1990-11-30
Entered: 1990-12-05
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 4918P2 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Asthma, Chills, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), 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? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3707

Write-up: Pt vaccinated with Fluzone developed temp. not recorded, but believed to be over 37 chills, weakness, asthma worsened.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180814&IDNUMBER=26896


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