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This is VAERS ID 26899

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

Case Details

VAERS ID: 26899 (history)  
Form: Version .0  
Age: 40.5  
Sex: Female  
Location: California  
Vaccinated:1990-11-15
Onset:1990-11-18
   Days after vaccination:3
Submitted: 1990-11-19
   Days after onset:1
Entered: 1990-12-07
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11203 / 0 LA / IM
TD: TD ADSORBED, ADULTS / SCLAVO 136A1 / - RA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: ASTHENIA, DYSPNEA, HEADACHE, PHARYNGITIS
SMQs:

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? No
Previous Vaccinations:
Other Medications: Ampicillin, Sudafed, Ear drops, Pain med
Current Illness: Ear infection that was reportedly clear
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with FLU/TD developed headache, itching throat, weak, tight chested & SOB.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=26899


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