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This is VAERS ID 26223

Case Details

VAERS ID: 26223 (history)  
Form: Version 1.0  
Age: 62.0  
Sex: Female  
Location: Idaho  
Vaccinated:1990-09-21
Onset:1990-09-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site reaction
SMQs:

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

Write-up: Pt vaccinated with Flu Tirvalent experienced inflammation and itchyness at vaccine site.


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