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This is VAERS ID 26709

Case Details

VAERS ID: 26709 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:1990-11-01
Onset:1990-11-01
   Days after vaccination:0
Submitted: 1990-11-02
   Days after onset:1
Entered: 1990-11-21
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 11203 / UNK LA / -
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 285909 / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA903

Write-up: Pt vaccinated Pnuemococcal/FLU rt arm now swollen, wrist to shoulder. No known allergies.


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