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This is VAERS ID 26638

Case Details

VAERS ID: 26638 (history)  
Form: Version 1.0  
Age: 21.0  
Sex: Female  
Location: Washington  
Vaccinated:1990-11-09
Onset:1990-11-09
   Days after vaccination:0
Submitted: 1990-11-12
   Days after onset:3
Entered: 1990-11-14
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 02280P / 1 - / IM A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Chills, Headache, Hyperhidrosis, Malaise
SMQs:, Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (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: Vit C, Zantac, A cyclored
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Influenza A/B first time got flu shot. General malaise, headache, fatigue, cold, clammy.


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