VAERS ID: |
25075 (history) |
Form: |
Version 1.0 |
Age: |
43.0 |
Sex: |
Female |
Location: |
New Jersey |
Vaccinated: | 1989-11-07 |
Onset: | 1989-11-07 |
Days after vaccination: | 0 |
Submitted: |
1989-11-09 |
Days after onset: | 2 |
Entered: |
1990-07-09 |
Days after submission: | 241 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH |
4898169 / UNK |
- / IM |
Administered by: Private Purchased by: Unknown Symptoms: Arthralgia,
Arthritis,
Back pain,
Hypokinesia,
Injection site hypersensitivity,
Lymphadenopathy,
Neck pain,
Paraesthesia SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: B073089147
Write-up: Pt experienced a local reaction within 24 hrs at the site of injection, described as a bullseye, after receiving influenza virus vaccine. Also observed was supraclavicular swelling including lymph nodes. |