| 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)
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. |
