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This is VAERS ID 664115

Case Details

VAERS ID: 664115 (history)  
Form: Version 1.0  
Age: 82.0  
Gender: Female  
Location: Vermont  
Vaccinated:2016-09-02
Onset:2016-09-02
   Days after vaccination:0
Submitted: 2016-11-03
   Days after onset:62
Entered: 2016-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UI659AA / UNK LA / UN

Administered by: Other       Purchased by: Private
Symptoms: Abdominal pain upper, Chills, Headache, Pneumonia, Red blood cell count, Tremor, X-ray
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine; lorazepam; CRESTOR; levothyroxine
Current Illness: None known
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: blood work (RBC), x-rays
CDC Split Type:

Write-up: Headache, shaking/shivers, stomach aches, went to ER on 9/18, had blood work done treated for pneumonia (with Z-pack) and for RBC.


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