National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 12/31/2003 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 27081

Government Disclaimer on use of this data



Case Details

VAERS ID: 27081 (history)  
Form: Version .0  
Age: 62.1  
Sex: Male  
Location: Michigan  
Vaccinated:1990-11-19
Onset:1990-11-21
   Days after vaccination:2
Submitted: 1990-11-26
   Days after onset:5
Entered: 1991-01-09
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11222 / 1 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: DYSPNEA, PARESTHESIA, PRURITUS
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: Theophyllin, Nifedipine, Captopril
Current Illness:
Preexisting Conditions: allergies to Penicillin, Naprosyn, ASA, Motrin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: shoulder & chest lt side were itching, discovered area numb when trying to scratch area, c/o SOB, numbness, denies numbness in neck afebrile advised to contact physician to r/o cardiac problems


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27081


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166