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This is VAERS ID 26246

Case Details

VAERS ID: 26246 (history)  
Form: Version 1.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:1990-10-04
Onset:1990-10-05
   Days after vaccination:1
Submitted: 1990-10-09
   Days after onset:4
Entered: 1990-10-15
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0F11209 / UNK LA / IM

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

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: VB12 Cyanocobalmin; Voltaren 25mg
Current Illness:
Preexisting Conditions: Shellfish
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Fluzone developed itching eyes; welts on body; size of quarter for a few hrs. pt took chlor-trimton


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