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This is VAERS ID 26669

Case Details

VAERS ID: 26669 (history)  
Form: Version 1.0  
Age: 39.0  
Sex: Male  
Location: Ohio  
Vaccinated:1990-11-05
Onset:1990-11-05
   Days after vaccination:0
Submitted: 1990-11-12
   Days after onset:7
Entered: 1990-11-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 02580P / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chills, Face oedema, Headache, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Librium, Tenex, Aspirin, Procardia XL
Current Illness:
Preexisting Conditions: Alcoholism, hypertension, coronary artery dis, demerol allergy causes Increased BP
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with Influenza developed nausea, headache, swelling in eyes & face, fever & chills. Treated w/Benadryl & Prednisone.


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