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This is VAERS ID 25075

Case Details

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.


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