| 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. |
