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This is VAERS ID 25069

Case Details

VAERS ID: 25069 (history)  
Form: Version 1.0  
Age: 34.0  
Sex: Male  
Location: Michigan  
Vaccinated:1989-11-09
Onset:1989-11-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH - / UNK - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: allery to penicillins & shell-fish
Allergies:
Diagnostic Lab Data:
CDC Split Type: B073089154

Write-up: Pt developed hives 6 days /p receiving Influenza Virus vaccine. As of January 22, 1990, it was reported that he had recovered


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