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This is VAERS ID 26491

Case Details

VAERS ID: 26491 (history)  
Form: Version 1.0  
Age: 70.0  
Sex: Female  
Location: Arizona  
Vaccinated:1990-10-22
Onset:1990-10-22
   Days after vaccination:0
Submitted: 1990-10-25
   Days after onset:3
Entered: 1990-11-05
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Oedema, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), 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: Lanoxin Thyroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Flu shot developed redness, swelling,rash. Injection was given 22OCT90. Pt did not report rx until it was gone on 25OCT90.


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