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This is VAERS ID 25751

Case Details

VAERS ID: 25751 (history)  
Form: Version 1.0  
Age: 63.0  
Sex: Female  
Location: Arizona  
Vaccinated:0000-00-00
Onset:1989-11-15
Submitted: 0000-00-00
Entered: 1990-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Hydroxizine, ASA
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 8902657.01

Write-up: Increasing, severe, generalized dermatitis of 2 wks duration. 1-2 days before onset received flu shot (Connaught) and Pnu-Imune.


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