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This is VAERS ID 27412

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

Case Details

VAERS ID: 27412 (history)  
Form: Version .0  
Age: 30.8  
Sex: Male  
Location: Washington  
Vaccinated:1990-12-31
Onset:1991-01-02
   Days after vaccination:2
Submitted: 1991-01-03
   Days after onset:1
Entered: 1991-01-16
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1990-1991 CONNAUGHT / CONNAUGHT LABS 0F11223 / 0 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: DIARRHEA, HEADACHE, MYALGIA, SWEAT, SYNCOPE
SMQs:

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hx asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx 40 min after immun developed cold sweats, blacked out upon arising; headache x 12 hrs; muscle ached, diarrhea, temp 97.0.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=27412


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