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This is VAERS ID 26641

Case Details

VAERS ID: 26641 (history)  
Form: Version 1.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:1990-11-09
Onset:1990-11-09
   Days after vaccination:0
Submitted: 1990-11-13
   Days after onset:4
Entered: 1990-11-14
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02280P / 1 - / IM A

Administered by: Unknown       Purchased by: Private
Symptoms: Chest pain, Pharyngitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Old reaction to ampicillin.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Influenza A/B chest tightness & pain. sore & hoarse throat.


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