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This is VAERS ID 69049

(NOTE: This result is from the 8/14/2018 version of the VAERS database)

Case Details

VAERS ID: 69049 (history)  
Form: Version 1.0  
Age: 23.0  
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: 1994-11-29
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4948125 / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Anuria, Blood creatinine increased, Glomerulonephritis, Haematuria, Immune system disorder, Laboratory test abnormal, Pyrexia, Serum sickness
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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: ~ ()~~~In patient
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: 894312004K

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


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180814&IDNUMBER=69049


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