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This is VAERS ID 69641

(NOTE: This result is from the 5/14/2017 version of the VAERS database)

Case Details

VAERS ID: 69641 (history)  
Form: Version .0  
Age: 49.0  
Sex: Male  
Location: Maryland  
Vaccinated:1993-11-02
Onset:1994-01-06
   Days after vaccination:65
Submitted: 1994-11-27
   Days after onset:325
Entered: 1994-12-16
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 3J41019 / - - / -

Administered by: Other       Purchased by: Public
Symptoms: Ecchymosis, Epistaxis, Petechiae, Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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, 30 days
   Extended hospital stay? No
Previous Vaccinations: in pt, allergy to pcn;~ ()~~~In patient
Other Medications: sudafed, advil, valium;
Current Illness: none;
Preexisting Conditions: allergies to milk,foods;tx w/ shots 10 years previously;
Allergies:
Diagnostic Lab Data: weekly platelets antibody testing;dx chronic idiopathyl thrombocytopenia purpura;
CDC Split Type:

Write-up: pt recvd vax;noticed decline in ability beginning w/ period p/ flu shot;petechia on legs,large bruises,cont nasal blood seepage;ITP dx mar94;5 hospitalizations w/ steroids gamma immune,decadrone P tx;platelet count responsive to decadrone;


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