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This is VAERS ID 26605

Case Details

VAERS ID: 26605 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Male  
Location: Virginia  
Vaccinated:1990-10-30
Onset:1990-10-30
   Days after vaccination:0
Submitted: 1990-11-01
   Days after onset:2
Entered: 1990-11-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES OF11200 / UNK RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chills, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: WBC 9000; BS 370; UA - negative
CDC Split Type:

Write-up: Pt vaccinated with Influenza vaccine developed temp 103; chills, Seen in ER that PM given Tylenol and labs done.


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