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This is VAERS ID 26619

Case Details

VAERS ID: 26619 (history)  
Form: Version 1.0  
Age: 54.0  
Sex: Female  
Location: Arizona  
Vaccinated:1990-10-31
Onset:1990-11-01
   Days after vaccination:1
Submitted: 1990-11-06
   Days after onset:5
Entered: 1990-11-13
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Injection site mass, Injection site reaction, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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: Tenormin, Prop
Current Illness: Peptic Ulcer, Back Pain
Preexisting Conditions: Lower back (L3, L4) surgery 2OCT90 Demerol in Hosp.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated next day redness 2in X 1 1/2in, 1/4in raised, hard not reported until 2NOV90 still red 6NOV, swelling down. Pt was unsure if nausea was from injection or from her ulcer.


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