| VAERS ID: |
46114 (history) |
| Form: |
Version 1.0 |
| Age: |
67.0 |
| Sex: |
Female |
| Location: |
Louisiana |
| Vaccinated: | 1991-11-01 |
| Onset: | 1991-11-16 |
| Days after vaccination: | 15 |
| Submitted: |
0000-00-00 |
| Entered: |
1992-10-13 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES |
1F21219 / 1 |
RA / - |
Administered by: Public Purchased by: Public
Symptoms: Back pain,
Hyperaesthesia,
Hyperglycaemia,
Hypochromic anaemia,
Laboratory test abnormal,
Leukopenia,
Neuropathy,
Pneumonia
SMQs:, Haematopoietic leukopenia (narrow), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: HGB-11.5; HCT 35.4, RDW 16.1;
CDC Split Type: LA921004
Write-up: about 2 wks p/shot woke up 2AM w/severe pain lower back & rt leg to knee 16NOV91; pt went to ER & adm to hosp seen by bone & joint specialist; nerve problem, glucose of 136; meralgia paresthetica; pneumonia, Hgb 11.5, WBC 4,500; |
