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This is VAERS ID 26497

Case Details

VAERS ID: 26497 (history)  
Form: Version 1.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:1990-10-25
Onset:1990-10-25
   Days after vaccination:0
Submitted: 1990-10-29
   Days after onset:4
Entered: 1990-11-05
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 01670P / 1 RA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 226928 / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Influenza/PNU-IMUNE approx 1 hr following administration of vaccine pt developed nausea, vomiting, fever lasting approx 12 hrs.


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