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This is VAERS ID 26615

Case Details

VAERS ID: 26615 (history)  
Form: Version 1.0  
Age: 49.0  
Sex: Male  
Location: Ohio  
Vaccinated:1990-10-25
Onset:1990-11-01
   Days after vaccination:7
Submitted: 1990-11-05
   Days after onset:4
Entered: 1990-11-13
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4908192 / UNK LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Herpes zoster, Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ascriptin, Sectal
Current Illness:
Preexisting Conditions: Previous allergic rx to B/P med
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Influenza Virus developed rash over trunk started 1NOV90, itches, temp 99.4. Rx Deltasone dose pack.


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