| VAERS ID: |
46528 (history) |
| Form: |
Version 1.0 |
| Age: |
94.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 1992-10-06 |
| Onset: | 1992-10-07 |
| Days after vaccination: | 1 |
| Submitted: |
1992-10-13 |
| Days after onset: | 6 |
| Entered: |
1992-10-28 |
| Days after submission: | 15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
- / UNK |
- / - |
Administered by: Other Purchased by: Other
Symptoms: Atrial fibrillation,
Dermatitis bullous,
Hallucination,
Herpes zoster,
Hypertension,
Pyrexia,
Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No
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: 892289001E
Write-up: Pt recvd flu vax the next evening devel a rash & some blisters on breasts & back; dx w/herpes zoster; tx Zovirax & DPH; also exp inc BP & hallucinations; adm to hosp 12OCT92; |
