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This is VAERS ID 26639

Case Details

VAERS ID: 26639 (history)  
Form: Version 1.0  
Age: 39.0  
Sex: Female  
Location: Washington  
Vaccinated:1990-11-09
Onset:1990-11-09
   Days after vaccination:0
Submitted: 1990-11-14
   Days after onset:5
Entered: 1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00280P / 1 - / IM A

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anxiety, Chest pain, Laryngospasm
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), 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:
Current Illness:
Preexisting Conditions: Allergic to house dust & pollen.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated wih Influenza A/B throat constricting, tightness in chest, anxiety.


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