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This is VAERS ID 69049

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

Case Details

VAERS ID: 69049 (history)  
Form: Version .0  
Age: 23.5  
Sex: Female  
Location: Maryland  
Vaccinated:1994-10-19
Onset:1994-10-20
   Days after vaccination:1
Submitted: 1994-11-02
   Days after onset:13
Entered: 1994-12-06
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUSHIELD 1994-1995 / WYETH 4948125 / - - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: ANURIA, CREATININE INC, FEVER, GLOMERULITIS, HEMATURIA
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Renal biopsy: anti-glomerular basement membrane antibodies $g 900; serum creatinine 2.1, 2.6, 3.4, 7.4 (dialysis started), 11.0; ASO titer 170; throat cx: nl flora;
CDC Split Type:

Write-up: pt recvd vax; subsequently adm to hosp w/ renal failure;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=69049


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